Provider Demographics
NPI:1982637351
Name:NIGHTINGALE HOME HEALTH AGENCY, INC.
Entity Type:Organization
Organization Name:NIGHTINGALE HOME HEALTH AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:REYES
Authorized Official - Last Name:DELATORRE
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:909-466-9382
Mailing Address - Street 1:9330 BASELINE ROAD, SUITE 201
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-5827
Mailing Address - Country:US
Mailing Address - Phone:909-466-9382
Mailing Address - Fax:909-466-9383
Practice Address - Street 1:9330 BASELINE ROAD, SUITE 201
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-5827
Practice Address - Country:US
Practice Address - Phone:909-466-9382
Practice Address - Fax:909-466-9383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000853251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058418Medicare Oscar/Certification