MEDICARE: TIFFANY CARE CENTERS

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	031599	MO

General Provider Information

NPI Number	:	1174511927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIFFANY CARE CENTERS

Provider Business Mailing Address
First Line	:	116 E PRATT ST
Second Line	:	P.O. BOX 129
City	:	BROOKFIELD
State	:	MO
Zip	:	64628-1337
Country	:	US
Telephone Number	:	660-258-7402
Fax Number	:	660-258-2364

Provider Business Practice Location Address
First Line	:	116 E PRATT ST
Second Line	:
City	:	BROOKFIELD
State	:	MO
Zip	:	64628-1337
Country	:	US
Telephone Number	:	660-258-7402
Fax Number	:	660-258-2364

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. TAMMIE HENDERSON
Credential	:	BS, MLNHA
Telephone Number	:	660-258-7402

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	08/22/2020

Similar Medicare Providers

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1265423461 — MRS. KARLA DENISE CLUBINE FNP/PNP
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Directions to “TIFFANY CARE CENTERS ” Practice Location

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