MEDICARE: TIFFANY CARE CENTERS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	032304	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033142153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIFFANY CARE CENTERS, INC

Provider Business Mailing Address
First Line	:	470 RAINBOW DR
Second Line	:	P.O BOX 273
City	:	ROCK PORT
State	:	MO
Zip	:	64482-1641
Country	:	US
Telephone Number	:	660-744-6252
Fax Number	:

Provider Business Practice Location Address
First Line	:	470 RAINBOW DR
Second Line	:
City	:	ROCK PORT
State	:	MO
Zip	:	64482-1641
Country	:	US
Telephone Number	:	660-744-6252
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LEN RHINE
Credential	:
Telephone Number	:	660-744-6252

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	08/03/2010

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