Provider Demographics
NPI:1891205910
Name:GIDEZ NURSING SERVICES LLC
Entity type:Organization
Organization Name:GIDEZ NURSING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GIDEON
Authorized Official - Middle Name:
Authorized Official - Last Name:EZIAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-804-1130
Mailing Address - Street 1:8902 LENNINGS LANE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237
Mailing Address - Country:US
Mailing Address - Phone:443-804-1130
Mailing Address - Fax:410-780-4940
Practice Address - Street 1:8902 LENNINGS LANE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237
Practice Address - Country:US
Practice Address - Phone:443-804-1130
Practice Address - Fax:410-780-4940
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIDEZ NURSING SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR152418163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty