Provider Demographics
NPI:1619295409
Name:TIFFANY CARE CENTERS, INC.
Entity Type:Organization
Organization Name:TIFFANY CARE CENTERS, INC.
Other - Org Name:NODAWAY NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-562-2876
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:22371 STATE HIGHWAY 46
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-8157
Mailing Address - Country:US
Mailing Address - Phone:660-562-2876
Mailing Address - Fax:660-562-7558
Practice Address - Street 1:22371 STATE HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-8157
Practice Address - Country:US
Practice Address - Phone:660-562-2876
Practice Address - Fax:660-562-7558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO037434314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26A500Medicaid
MO102385408Medicaid
MO265836Medicare Oscar/Certification