MEDICARE: NIGHTINGALE HOME HEALTH LLC

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	6363HHA-0	NV

General Provider Information

NPI Number	:	1407135080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIGHTINGALE HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	1913 BROKEN LANCE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-5090
Country	:	US
Telephone Number	:	702-331-5922
Fax Number	:	702-685-8761

Provider Business Practice Location Address
First Line	:	1913 BROKEN LANCE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-5090
Country	:	US
Telephone Number	:	702-331-5922
Fax Number	:	702-685-8761

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. FRANCIS NWABUEZE
Credential	:	RN, BSN
Telephone Number	:	702-331-5922

Provider Enumeration Date	:	08/12/2011
Last Update Date	:	06/09/2015

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