Provider Demographics
NPI:1053637363
Name:NIGHTINGALE HEALTH SERVICES
Entity Type:Organization
Organization Name:NIGHTINGALE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDEN
Authorized Official - Middle Name:YELLA
Authorized Official - Last Name:ACHU
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:240-602-6717
Mailing Address - Street 1:13002 LEDO CREEK TER
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-5105
Mailing Address - Country:US
Mailing Address - Phone:240-602-6717
Mailing Address - Fax:240-547-1161
Practice Address - Street 1:13002 LEDO CREEK TER
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-5105
Practice Address - Country:US
Practice Address - Phone:240-602-6717
Practice Address - Fax:240-547-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2840251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health