Provider Demographics
NPI:1013903301
Name:OHERBST INC
Entity Type:Organization
Organization Name:OHERBST INC
Other - Org Name:GUARDIAN HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGULATORY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-299-3020
Mailing Address - Street 1:3854 AMERICAN WAY STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4897
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:
Practice Address - Street 1:1411 MEMORIAL DR STE A
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5218
Practice Address - Country:US
Practice Address - Phone:979-774-7770
Practice Address - Fax:979-778-9435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011573251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX024509401Medicaid
TX677153Medicare Oscar/Certification