Provider Demographics
NPI:1205409174
Name:BY YOUR SIDE ARIZONA, LLC
Entity Type:Organization
Organization Name:BY YOUR SIDE ARIZONA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CONTRACTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZICKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-590-5571
Mailing Address - Street 1:8201 CASS AVE
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-5314
Mailing Address - Country:US
Mailing Address - Phone:630-590-5571
Mailing Address - Fax:
Practice Address - Street 1:8201 CASS AVE
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-5314
Practice Address - Country:US
Practice Address - Phone:630-590-5571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities