Provider Demographics
NPI:1689858185
Name:TIFFANYS ADULT CARE HOME
Entity Type:Organization
Organization Name:TIFFANYS ADULT CARE HOME
Other - Org Name:TIFFANYS FAMILY CARE HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HELENA
Authorized Official - Middle Name:B
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-722-3755
Mailing Address - Street 1:PO BOX 241
Mailing Address - Street 2:TIFFANYS ADULT CARE HOME
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-4649
Mailing Address - Country:US
Mailing Address - Phone:919-772-3755
Mailing Address - Fax:919-359-8386
Practice Address - Street 1:1139A BENSON RD
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-4649
Practice Address - Country:US
Practice Address - Phone:919-772-3755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCH092035261QH0100X
NC261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804699Medicaid