Provider Demographics
NPI:1225015563
Name:NIGHTINGALE HOME CARE, INC.
Entity Type:Organization
Organization Name:NIGHTINGALE HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:619-337-1888
Mailing Address - Street 1:4579 MAPLE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-3154
Mailing Address - Country:US
Mailing Address - Phone:619-337-1888
Mailing Address - Fax:619-337-1072
Practice Address - Street 1:4579 MAPLE AVE. STE. 2
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941
Practice Address - Country:US
Practice Address - Phone:619-337-1888
Practice Address - Fax:619-337-1072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000783251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058287Medicare ID - Type UnspecifiedHOME HEALTH