MEDICARE: NIGHTINGALE REHABILITATION, 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	114923	TX

General Provider Information

NPI Number	:	1316973696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIGHTINGALE REHABILITATION, INC.

Provider Business Mailing Address
First Line	:	5802 HOLLY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-7838
Country	:	US
Telephone Number	:	713-981-1543
Fax Number	:	713-995-6376

Provider Business Practice Location Address
First Line	:	8103 DUNLAP ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-7828
Country	:	US
Telephone Number	:	713-981-1571
Fax Number	:	713-981-1571

Authorized Official
Title or Position	:	ONWER
Name	:	MR. PHILIP CHUNG
Credential	:
Telephone Number	:	713-981-1543

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	08/22/2020

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