Basic Information
Provider Information | |||||||||
NPI: | 1770719353 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NIGHTINGALE STAFFING, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
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: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SIMS | ||||||||
AuthorizedOfficialFirstName: | HAROLD | ||||||||
AuthorizedOfficialMiddleName: | C | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 8009205161 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: | II | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 034R0005 | GA | Y |   | Agencies | Home Health |   |
ID Information
ID | Type | State | Issuer | Description | 000407965I | 05 | GA |   | MEDICAID | 000407965U | 05 | GA |   | MEDICAID |