MEDICARE: NIGHTINGALE NURSING AND 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	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1568070084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIGHTINGALE NURSING AND HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	405 PASEO DE PERALTA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87501-1938
Country	:	US
Telephone Number	:	505-310-4450
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 PASEO DE PERALTA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87501-1938
Country	:	US
Telephone Number	:	505-310-4450
Fax Number	:

Authorized Official
Title or Position	:	DIRECTING MANAGER
Name	:	HAIDE MARTINEZ
Credential	:
Telephone Number	:	505-531-0202

Provider Enumeration Date	:	07/21/2020
Last Update Date	:	08/06/2024

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