Healthcare Provider Details

I. General information

NPI: 1992470488
Provider Name (Legal Business Name): NIGISTI HISMITH MINISTRIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 BAXTER AVE STE 205
LOUISVILLE KY
40204-1198
US

IV. Provider business mailing address

424 E CENTRAL BLVD # 545
ORLANDO FL
32801-1923
US

V. Phone/Fax

Practice location:
  • Phone: 407-917-2028
  • Fax:
Mailing address:
  • Phone: 407-917-2028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: NIGISTI HISMITH
Title or Position: EXECUTIVE DIRECT
Credential:
Phone: 319-669-9312