Provider Demographics
NPI:1144394313
Name:TIFFANY CARE CENTERS, INC
Entity Type:Organization
Organization Name:TIFFANY CARE CENTERS, INC
Other - Org Name:TIFFANY IN HOME SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILBURN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:660-442-3128
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:1105 STATE ST
Mailing Address - City:MOUND CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64470-0308
Mailing Address - Country:US
Mailing Address - Phone:660-442-3128
Mailing Address - Fax:660-442-3717
Practice Address - Street 1:1105 STATE ST
Practice Address - Street 2:
Practice Address - City:MOUND CITY
Practice Address - State:MO
Practice Address - Zip Code:64470-0308
Practice Address - Country:US
Practice Address - Phone:660-442-3128
Practice Address - Fax:660-442-3717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X, 372600000X, 373H00000X, 374700000X, 3747A0650X, 3747P1801X, 374T00000X, 374U00000X, 376G00000X, 376K00000X
MO376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
Not Answered372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
Not Answered373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
Not Answered374700000XNursing Service Related ProvidersTechnicianGroup - Multi-Specialty
Not Answered3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
Not Answered3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Not Answered374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing PersonnelGroup - Multi-Specialty
Not Answered374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Not Answered376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Multi-Specialty
Not Answered376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Not Answered376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty