Provider Demographics
NPI:1528162542
Name:TIFFANY CARE CENTERS, INC
Entity type:Organization
Organization Name:TIFFANY CARE CENTERS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:IRELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-442-3128
Mailing Address - Street 1:1105 STATE ST
Mailing Address - Street 2:PO BOX 308
Mailing Address - City:MOUND CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64470-7202
Mailing Address - Country:US
Mailing Address - Phone:660-442-3128
Mailing Address - Fax:
Practice Address - Street 1:1105 STATE ST
Practice Address - Street 2:
Practice Address - City:MOUND CITY
Practice Address - State:MO
Practice Address - Zip Code:64470-7202
Practice Address - Country:US
Practice Address - Phone:660-442-3128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A372500000X, 163W00000X, 372600000X, 374U00000X, 376K00000X, 376G00000X, 374700000X, 3747A0650X, 3747P1801X, 376J00000X
MO374T00000X, 373H00000X, 251J00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing PersonnelGroup - Multi-Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Multi-Specialty
No374700000XNursing Service Related ProvidersTechnicianGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO263663403Medicaid
MO0001438OtherSOCIAL SVS BLOCK GRANT