Organization
TIFFANY FAMILY CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GODWIN WILLIAMS (EXECUTIVE DIRECTOR)
(336) 373-1285
Entity
Organization
Contact information
Practice address
702 MCPHEARSON STREET, GREENSBORO, NC 27405
(336) 333-9292
Mailing address
1014 HOMELAND AVE STE 101, GREENSBORO, NC 27405-7015
(336) 373-1285
(336) 373-1192
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-041-684
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603615
—
NC
Enumeration date
12/19/2006
Last updated
08/22/2020
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