Basic Information
| Provider Information | |||||||||
| NPI: | 1558372623 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NIGHTINGALE SERVICES, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | NIGHTINGALE SERVICES, INC. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 9100 WHITE BLUFF RD | ||||||||
| Address2: | STE 301 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314064670 | ||||||||
| 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: | 08/11/2006 | ||||||||
| LastUpdateDate: | 04/28/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KAESER | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO / OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9123556472 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 029R0016 | GA | N | Agencies | Home Health | 251E00000X | 011R0045 | GA | N | Agencies | Home Health | 251E00000X | 016R0006 | GA | N | Agencies | Home Health | 251E00000X | 034R0005 | GA | N | Agencies | Home Health | 251E00000X | 008R0396 | GA | N | Agencies | Home Health | 251E00000X | 083R0538 | GA | N | Agencies | Home Health | 251E00000X | 047R0656 | GA | N | Agencies | Home Health | 251E00000X | 020-R-0898 | GA | N | Agencies | Home Health | 251E00000X | 093-R-0970 | GA | N | Agencies | Home Health | 251E00000X | 106-R-1104 | GA | N | Agencies | Home Health | 251E00000X | N | Agencies | Home Health | 251E00000X | 121R0416 | GA | N | Agencies | Home Health | 251E00000X | 025R0022 | GA | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 000407965AI | 05 | GA | MEDICAID | 000407965O | 05 | GA | MEDICAID | 000407965S | 05 | GA | MEDICAID | 000407965T | 05 | GA | MEDICAID | 00407965H | 05 | GA | MEDICAID | 000407965AA | 05 | GA | MEDICAID | 000407965AB | 05 | GA | MEDICAID | 000407965X | 05 | GA | MEDICAID | 000407965AC | 05 | GA | MEDICAID | 000407965N | 05 | GA | MEDICAID | 000407965W | 05 | GA | MEDICAID | 000407965AF | 05 | GA | MEDICAID | 000407965R | 05 | GA | MEDICAID | 000407965C | 05 | GA | MEDICAID | 000407965P | 05 | GA | MEDICAID | 000407965Y | 05 | GA | MEDICAID | 000407965AE | 05 | GA | MEDICAID | 000407965AH | 05 | GA | MEDICAID | 000407965I | 05 | GA | MEDICAID | 000407965U | 05 | GA | MEDICAID | 000407965B | 05 | GA | MEDICAID | 000407965V | 05 | GA | MEDICAID | 000407965AG | 05 | GA | MEDICAID | 000407965Q | 05 | GA | MEDICAID | 00407965F | 05 | GA | MEDICAID |