=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982637351
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NIGHTINGALE HOME HEALTH AGENCY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2006
-----------------------------------------------------
Last Update Date | 02/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9330 BASELINE ROAD, SUITE 201
-----------------------------------------------------
City | RANCHO CUCAMONGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91701-5827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-466-9382
-----------------------------------------------------
Fax | 909-466-9383
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9330 BASELINE ROAD, SUITE 201
-----------------------------------------------------
City | RANCHO CUCAMONGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91701-5827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-466-9382
-----------------------------------------------------
Fax | 909-466-9383
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/CEO
-----------------------------------------------------
Name | MS. THERESA REYES DELATORRE
-----------------------------------------------------
Credential | BA
-----------------------------------------------------
Telephone | 909-466-9382
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 240000853
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------