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General NPI Number Information
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NPI Number | 1619295409
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Entity Type | Organization
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Legal Business Name | TIFFANY CARE CENTERS, INC.
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Dates
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Enumeration Date | 05/04/2010
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 22371 STATE HIGHWAY 46
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City | MARYVILLE
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State | MO
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Zip | 64468-8157
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Country | US
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Telephone | 660-562-2876
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Fax | 660-562-7558
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Provider Business Mailing Address
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Address Line | PO BOX 307 22371 STATE HIGHWAY 46
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City | MARYVILLE
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State | MO
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Zip | 64468-8157
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Country | US
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Telephone | 660-562-2876
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Fax | 660-562-7558
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. KELLY SUMMA
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Credential |
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Telephone | 660-562-2876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 037434
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License Number State | MO
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