Basic Information
| Provider Information | |||||||||
| NPI: | 1861021156 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NIGHTINGALE INFUSION INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9100 WHITE BLUFF RD STE 603 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314064674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123556472 | ||||||||
| FaxNumber: | 9126914716 | ||||||||
| Practice Location | |||||||||
| Address1: | 9100 WHITE BLUFF RD STE 603 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314064674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123556472 | ||||||||
| FaxNumber: | 9126914716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2020 | ||||||||
| LastUpdateDate: | 05/31/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FRIES | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
| AuthorizedOfficialMiddleName: | CARLA | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9123556472 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | 1861021156 | ||||||||
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| NPICertificationDate: | 05/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | N | Agencies | Home Health | 3336H0001X | N | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy | 251F00000X | Y | Agencies | Home Infusion |
No ID Information.