# TIFT COUNTY BOARD OF HEALTH D/B/A DIVERSIFIED ENTERPRISES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710272497
- **Authorized official:** THERESA DURDEN (WEB PORTAL MANAGER)
- **Authorized official phone:** (229) 386-3122

## Contact information

- **Practice address:** 192 VIRGINIA AVE S, SUITE 100, TIFTON, GA 31794-8074
- **Practice address phone:** (229) 386-3122
- **Practice address fax:** (229) 386-7156
- **Mailing address:** 192 VIRGINIA AVE S, SUITE 100, TIFTON, GA 31794-8074
- **Mailing address phone:** (229) 386-3122
- **Mailing address fax:** (229) 386-7156

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 06/10/2011
- **Last updated:** 06/10/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000682613L | — | GA |