1861589079 NPI number — E. NIGHTINGALE ENTERPRISES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861589079 NPI number — E. NIGHTINGALE ENTERPRISES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
E. NIGHTINGALE ENTERPRISES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861589079
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
710 FRABLE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROADHEADSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-764-4706
Provider Business Mailing Address Fax Number:
570-402-2056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 FRABLE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROADHEADSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-764-4706
Provider Business Practice Location Address Fax Number:
570-402-2056
Provider Enumeration Date:
10/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRAVETTE
Authorized Official First Name:
ELLYN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CLINICIAN
Authorized Official Telephone Number:
570-764-4706

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  SW012506L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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