MEDICARE: TIFFANY DANIELLE MCGARY BS

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility		NE

General Provider Information

NPI Number	:	1114858461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY DANIELLE MCGARY BS

Provider Business Mailing Address
First Line	:	1522 N 40TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68111-4009
Country	:	US
Telephone Number	:	402-212-1110
Fax Number	:

Provider Business Practice Location Address
First Line	:	1522 N 40TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68111-4009
Country	:	US
Telephone Number	:	402-212-1110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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