Healthcare Provider Details

I. General information

NPI: 1568070084
Provider Name (Legal Business Name): NIGHTINGALE NURSING AND HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 PASEO DE PERALTA
SANTA FE NM
87501-1938
US

IV. Provider business mailing address

405 PASEO DE PERALTA
SANTA FE NM
87501-1938
US

V. Phone/Fax

Practice location:
  • Phone: 505-310-4450
  • Fax:
Mailing address:
  • Phone: 505-310-4450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: HAIDE MARTINEZ
Title or Position: DIRECTING MANAGER
Credential:
Phone: 505-531-0202