Provider Demographics
NPI:1861589079
Name:E. NIGHTINGALE ENTERPRISES, INC.
Entity type:Organization
Organization Name:E. NIGHTINGALE ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ELLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAVETTE
Authorized Official - Suffix:
Authorized Official - Credentials:LSW, CADC, CEAP
Authorized Official - Phone:570-764-4706
Mailing Address - Street 1:710 FRABLE ROAD
Mailing Address - Street 2:
Mailing Address - City:BROADHEADSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18322
Mailing Address - Country:US
Mailing Address - Phone:570-764-4706
Mailing Address - Fax:570-402-2056
Practice Address - Street 1:710 FRABLE ROAD
Practice Address - Street 2:
Practice Address - City:BROADHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322
Practice Address - Country:US
Practice Address - Phone:570-764-4706
Practice Address - Fax:570-402-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW012506L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty