Provider Demographics
NPI:1346571908
Name:NESBURG INC DBA GUARDIAN COMMUNITY HEALTH SYSTEMS
Entity type:Organization
Organization Name:NESBURG INC DBA GUARDIAN COMMUNITY HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GBENGA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBATUASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-800-4572
Mailing Address - Street 1:20 PLEASANT RIDGE DR STE E
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-2560
Mailing Address - Country:US
Mailing Address - Phone:410-800-4572
Mailing Address - Fax:410-286-1923
Practice Address - Street 1:20 PLEASANT RIDGE DR STE E
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-2560
Practice Address - Country:US
Practice Address - Phone:410-800-4572
Practice Address - Fax:410-286-1923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2846251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD24247Medicaid