Provider Demographics
NPI:1790483642
Name:TIFFANY HEALTHCARE LLC
Entity Type:Organization
Organization Name:TIFFANY HEALTHCARE LLC
Other - Org Name:TIFFANY HEIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOSP
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:ZUCCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-564-6978
Mailing Address - Street 1:12401 E 43RD ST S STE 201
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5911
Mailing Address - Country:US
Mailing Address - Phone:816-564-6978
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:2023-02-20
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility