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General NPI Number Information
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NPI Number | 1770003535
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Entity Type | Organization
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Legal Business Name | TIFFANIE MANOR FOR YOUNG ADULTS
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Dates
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Enumeration Date | 06/22/2017
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Last Update Date | 06/22/2017
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Provider Practice Location Address
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Address Line | 115 N JEFFERSON ST
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City | RICHMOND
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State | VA
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Zip | 23220-5021
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Country | US
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Telephone | 804-648-6924
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Fax | 804-644-3649
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Provider Business Mailing Address
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Address Line | PO BOX 4685
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City | RICHMOND
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State | VA
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Zip | 23220-8685
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Country | US
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Telephone | 804-648-6924
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Fax | 804-644-3649
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOSEPHINE GATLING
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Credential |
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Telephone | 804-648-6924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State | VA
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