Provider Demographics
NPI:1356332803
Name:NIGHTINGALE HOME HEALTHCARE OF MINNESOTA, INC
Entity Type:Organization
Organization Name:NIGHTINGALE HOME HEALTHCARE OF MINNESOTA, INC
Other - Org Name:NIGHTINGALE HOME HEALTHCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEV
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-334-7777
Mailing Address - Street 1:PO BOX 1710
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46082-1710
Mailing Address - Country:US
Mailing Address - Phone:866-334-7777
Mailing Address - Fax:866-878-0094
Practice Address - Street 1:10550 WAYZATA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1523
Practice Address - Country:US
Practice Address - Phone:763-545-3131
Practice Address - Fax:763-546-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN073425000Medicaid
MN248085Medicare ID - Type Unspecified