Provider Demographics
NPI:1801477203
Name:ROUNTREE, TIFFIANY S (ADMINISTRATOR, OWNER)
Entity type:Individual
Prefix:MS
First Name:TIFFIANY
Middle Name:S
Last Name:ROUNTREE
Suffix:
Gender:F
Credentials:ADMINISTRATOR, OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 CROWFOOT DR
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-2652
Mailing Address - Country:US
Mailing Address - Phone:757-790-5040
Mailing Address - Fax:
Practice Address - Street 1:310 CROWFOOT DR
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-2652
Practice Address - Country:US
Practice Address - Phone:757-790-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities