Provider Demographics
NPI:1770003535
Name:TIFFANIE MANOR FOR YOUNG ADULTS
Entity type:Organization
Organization Name:TIFFANIE MANOR FOR YOUNG ADULTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GATLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-648-6924
Mailing Address - Street 1:PO BOX 4685
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-8685
Mailing Address - Country:US
Mailing Address - Phone:804-648-6924
Mailing Address - Fax:804-644-3649
Practice Address - Street 1:115 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-5021
Practice Address - Country:US
Practice Address - Phone:804-648-6924
Practice Address - Fax:804-644-3649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness