Basic Information
| Provider Information | |||||||||
| NPI: | 1104150408 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NIGHTINGALE HOSPICE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 606 W COURT ST | ||||||||
| Address2: | |||||||||
| City: | WRIGHTSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310961200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123556472 | ||||||||
| FaxNumber: | 9126914716 | ||||||||
| Practice Location | |||||||||
| Address1: | 606 W COURT ST | ||||||||
| Address2: | |||||||||
| City: | WRIGHTSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310961200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123556472 | ||||||||
| FaxNumber: | 9126914716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2009 | ||||||||
| LastUpdateDate: | 09/21/2009 | ||||||||
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| AuthorizedOfficialLastName: | MCDOWELL | ||||||||
| AuthorizedOfficialFirstName: | COREY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9123556472 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 083-0326-H | GA | Y | Agencies | Hospice Care, Community Based |
No ID Information.