=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457664351
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NIGHTINGALE PRIVATE CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2010
-----------------------------------------------------
Last Update Date | 08/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 729 SW FEDERAL HWY STE 222
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34994-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-245-8390
-----------------------------------------------------
Fax | 772-245-8401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1165 NORTHCHASE PKWY SE STE 250
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30067-6432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-421-0191
-----------------------------------------------------
Fax | 772-600-8474
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SVP OF COMPLIANCE
-----------------------------------------------------
Name | MR. MARCY LYNCH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 470-392-9412
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 299993574
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------