MEDICARE: NIGHTINGALE HOME HEALTHCARE OF OREGON, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1295085991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIGHTINGALE HOME HEALTHCARE OF OREGON, INC.

Provider Business Mailing Address
First Line	:	1036 S RANGE LINE RD
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-2544
Country	:	US
Telephone Number	:	317-334-7777
Fax Number	:	317-569-1403

Provider Business Practice Location Address
First Line	:	2605 CROSBY AVE
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-5726
Country	:	US
Telephone Number	:	541-274-6293
Fax Number	:	541-274-6294

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DEV A BRAR
Credential	:
Telephone Number	:	317-334-7777

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	09/11/2012

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