# TIFFANY FAMILY CARE HOME

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

## Provider details

- **NPI number:** 1952464968
- **Authorized official:** MR. GODWIN WILLIAMS (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (336) 373-1285

## Contact information

- **Practice address:** 702 MCPHEARSON STREET, GREENSBORO, NC 27405
- **Practice address phone:** (336) 333-9292
- **Mailing address:** 1014 HOMELAND AVE STE 101, GREENSBORO, NC 27405-7015
- **Mailing address phone:** (336) 373-1285
- **Mailing address fax:** (336) 373-1192

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL-041-684 | NC | Yes |

## Other

- **Enumeration date:** 12/19/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6603615 | — | NC |