Provider Demographics
NPI:1124207634
Name:SIDE BY SIDE WORKING TOGETHER
Entity Type:Organization
Organization Name:SIDE BY SIDE WORKING TOGETHER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MAYBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-321-7753
Mailing Address - Street 1:316 30TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-4225
Mailing Address - Country:US
Mailing Address - Phone:941-749-5486
Mailing Address - Fax:941-749-5486
Practice Address - Street 1:316 30TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-4225
Practice Address - Country:US
Practice Address - Phone:941-749-5486
Practice Address - Fax:941-749-5486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services