Provider Demographics
NPI:1558394668
Name:TIFFANY CARE CENTERS, INC.
Entity Type:Organization
Organization Name:TIFFANY CARE CENTERS, INC.
Other - Org Name:TIFFANY HEIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOCUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-442-3146
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:MOUND CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64470-0308
Mailing Address - Country:US
Mailing Address - Phone:660-442-3146
Mailing Address - Fax:
Practice Address - Street 1:1531 NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:MOUND CITY
Practice Address - State:MO
Practice Address - Zip Code:64470-1610
Practice Address - Country:US
Practice Address - Phone:660-442-3146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO035785314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101496909Medicaid
MO265746Medicare Oscar/Certification