Healthcare Provider Details

I. General information

NPI: 1356332803
Provider Name (Legal Business Name): NIGHTINGALE HOME HEALTHCARE OF MINNESOTA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10550 WAYZATA BLVD STE 1
MINNETONKA MN
55305-1523
US

IV. Provider business mailing address

PO BOX 1710
CARMEL IN
46082-1710
US

V. Phone/Fax

Practice location:
  • Phone: 763-545-3131
  • Fax: 763-546-1191
Mailing address:
  • Phone: 866-334-7777
  • Fax: 866-878-0094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DEV A BRAR
Title or Position: PRESIDENT
Credential:
Phone: 317-334-7777