MEDICARE: TIFFANY'S COMPASSIONATE CARE LLC

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	251E00000X	Home Health Agency	230007522681002	MI

General Provider Information

NPI Number	:	1780057596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIFFANY'S COMPASSIONATE CARE LLC

Provider Business Mailing Address
First Line	:	534 WESTBROOK
Second Line	:
City	:	WHITMORE LAKE
State	:	MI
Zip	:	48189-8212
Country	:	US
Telephone Number	:	734-730-4175
Fax Number	:

Provider Business Practice Location Address
First Line	:	534 WESTBROOK
Second Line	:
City	:	WHITMORE LAKE
State	:	MI
Zip	:	48189-8212
Country	:	US
Telephone Number	:	734-730-4175
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	TIFFANY BRIANA COPELAND
Credential	:	CNA
Telephone Number	:	734-657-5117

Provider Enumeration Date	:	11/03/2015
Last Update Date	:	11/03/2015

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