Provider Demographics
NPI:1164966537
Name:TIFFANY'S HOMECARE SERVICES LLC
Entity Type:Organization
Organization Name:TIFFANY'S HOMECARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-292-1994
Mailing Address - Street 1:733 SW COUNTY ROAD 242A
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-2119
Mailing Address - Country:US
Mailing Address - Phone:386-292-1994
Mailing Address - Fax:
Practice Address - Street 1:733 SW COUNTY ROAD 242A
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-2119
Practice Address - Country:US
Practice Address - Phone:386-292-1994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care