Provider Demographics
NPI:1174511927
Name:TIFFANY CARE CENTERS
Entity Type:Organization
Organization Name:TIFFANY CARE CENTERS
Other - Org Name:MCLARNEY MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MLNHA
Authorized Official - Phone:660-258-7402
Mailing Address - Street 1:116 E PRATT ST
Mailing Address - Street 2:P.O. BOX 129
Mailing Address - City:BROOKFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:64628-1337
Mailing Address - Country:US
Mailing Address - Phone:660-258-7402
Mailing Address - Fax:660-258-2364
Practice Address - Street 1:116 E PRATT ST
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:MO
Practice Address - Zip Code:64628-1337
Practice Address - Country:US
Practice Address - Phone:660-258-7402
Practice Address - Fax:660-258-2364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031599314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility