MEDICARE: TIFFANY HEALTHCARE, 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	310400000X	Assisted Living Facility	HAL-007-008	NC

General Provider Information

NPI Number	:	1437480274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIFFANY HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	2294 GALLBERRY RD
Second Line	:
City	:	WASHINGTON
State	:	NC
Zip	:	27889-9178
Country	:	US
Telephone Number	:	252-946-6617
Fax Number	:	252-946-2313

Provider Business Practice Location Address
First Line	:	609 W 2ND ST
Second Line	:
City	:	WASHINGTON
State	:	NC
Zip	:	27889-4806
Country	:	US
Telephone Number	:	252-946-1701
Fax Number	:	252-946-1701

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS TIFFANY COLLETTE EVERETT
Credential	:
Telephone Number	:	252-946-6617

Provider Enumeration Date	:	01/19/2010
Last Update Date	:	01/19/2010

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Directions to “TIFFANY HEALTHCARE, INC. ” Practice Location

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