Basic Information
Provider Information
NPI: 1770719353
EntityType: 2
ReplacementNPI:  
OrganizationName: NIGHTINGALE STAFFING, INC
LastName:  
FirstName:  
MiddleName:  
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Credential:  
OtherOrganizationName:  
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Mailing Information
Address1: 208 PETERSON AVE S STE 4
Address2:  
City: DOUGLAS
State: GA
PostalCode: 315335239
CountryCode: US
TelephoneNumber: 8006624207
FaxNumber:  
Practice Location
Address1: 9100 WHITE BLUFF RD STE 301
Address2:  
City: SAVANNAH
State: GA
PostalCode: 314064670
CountryCode: US
TelephoneNumber: 8009205161
FaxNumber: 9126914716
Other Information
ProviderEnumerationDate: 06/09/2009
LastUpdateDate: 06/09/2009
NPIDeactivationReasonCode:  
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NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: SIMS
AuthorizedOfficialFirstName: HAROLD
AuthorizedOfficialMiddleName: C
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 8009205161
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix: II
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251E00000X034R0005GAY AgenciesHome Health 

ID Information
IDTypeStateIssuerDescription
000407965I05GA MEDICAID
000407965U05GA MEDICAID


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