Provider Demographics
NPI:1053433631
Name:NIGHTINGALE NURSES HOME HEALTH AGENCY
Entity type:Organization
Organization Name:NIGHTINGALE NURSES HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRESHELLE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:WINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-228-8283
Mailing Address - Street 1:1510 N HAMPTON RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-8300
Mailing Address - Country:US
Mailing Address - Phone:972-228-8283
Mailing Address - Fax:972-228-8286
Practice Address - Street 1:1510 N HAMPTON RD
Practice Address - Street 2:SUITE 210
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-8300
Practice Address - Country:US
Practice Address - Phone:972-228-8283
Practice Address - Fax:972-228-8286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002007251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677197Medicare Oscar/Certification