Provider Demographics
NPI:1437480274
Name:TIFFANY HEALTHCARE, INC.
Entity Type:Organization
Organization Name:TIFFANY HEALTHCARE, INC.
Other - Org Name:WASHINGTON MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:COLLETTE
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-946-6617
Mailing Address - Street 1:2294 GALLBERRY RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-9178
Mailing Address - Country:US
Mailing Address - Phone:252-946-6617
Mailing Address - Fax:252-946-2313
Practice Address - Street 1:609 W 2ND ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4806
Practice Address - Country:US
Practice Address - Phone:252-946-1701
Practice Address - Fax:252-946-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-007-008310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility