Basic Information
| Provider Information | |||||||||
| NPI: | 1033317292 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NIGHTINGALE MEDICARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9100 WHITE BLUFF RD | ||||||||
| Address2: | STE 301 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123556472 | ||||||||
| FaxNumber: | 9126914716 | ||||||||
| Practice Location | |||||||||
| Address1: | 9100 WHITE BLUFF RD | ||||||||
| Address2: | STE 301 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123556472 | ||||||||
| FaxNumber: | 9126914716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2007 | ||||||||
| LastUpdateDate: | 07/19/2007 | ||||||||
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| AuthorizedOfficialLastName: | SIMS | ||||||||
| AuthorizedOfficialFirstName: | HAROLD | ||||||||
| AuthorizedOfficialMiddleName: | CLARK | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9123556472 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | II | ||||||||
| AuthorizedOfficialCredential: | MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | GA | Y | Agencies | Home Health |
No ID Information.