Healthcare Provider Details

I. General information

NPI: 1174867931
Provider Name (Legal Business Name): NIGHTINGALE HOME HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2012
Last Update Date: 11/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

788 CROMWELL CT
FREDERICK MD
21701-4445
US

IV. Provider business mailing address

788 CROMWELL CT
FREDERICK MD
21701-4445
US

V. Phone/Fax

Practice location:
  • Phone: 301-698-8789
  • Fax: 301-698-8789
Mailing address:
  • Phone: 301-305-5731
  • Fax: 301-698-8789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion
License NumberR3321
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care
License NumberR3321
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health
License NumberR3321
License Number StateMD

VIII. Authorized Official

Name: JULIA LUDOVICK SHIRIMA
Title or Position: CEO
Credential: RN
Phone: 301-305-5731