Healthcare Provider Details

I. General information

NPI: 1437378155
Provider Name (Legal Business Name): TIFFANY HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 MARKET STREET EXT
WASHINGTON NC
27889-8127
US

IV. Provider business mailing address

2294 GALLBERRY RD
WASHINGTON NC
27889-9178
US

V. Phone/Fax

Practice location:
  • Phone: 252-948-0838
  • Fax: 252-948-0838
Mailing address:
  • Phone: 252-946-6617
  • Fax: 252-946-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberHAL007010
License Number StateNC

VIII. Authorized Official

Name: MISS TIFFANY COLLETTE EVERETT
Title or Position: PRESIDENT
Credential:
Phone: 252-946-6617