MEDICARE: NIGHTINGALE HOME HEALTH AGENCY, 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	240000853	CA

General Provider Information

NPI Number	:	1982637351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIGHTINGALE HOME HEALTH AGENCY, INC.

Provider Business Mailing Address
First Line	:	9330 BASELINE ROAD, SUITE 201
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91701-5827
Country	:	US
Telephone Number	:	909-466-9382
Fax Number	:	909-466-9383

Provider Business Practice Location Address
First Line	:	9330 BASELINE ROAD, SUITE 201
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91701-5827
Country	:	US
Telephone Number	:	909-466-9382
Fax Number	:	909-466-9383

Authorized Official
Title or Position	:	ADMINISTRATOR/CEO
Name	:	MS. THERESA REYES DELATORRE
Credential	:	BA
Telephone Number	:	909-466-9382

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	02/19/2010

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