Provider Demographics
NPI:1326761651
Name:WOMEN AT YOUR SIDE AND COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:WOMEN AT YOUR SIDE AND COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKIE
Authorized Official - Suffix:
Authorized Official - Credentials:CPLC, CCTS, CDVS
Authorized Official - Phone:862-704-4829
Mailing Address - Street 1:259 MERCER ST
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-3132
Mailing Address - Country:US
Mailing Address - Phone:862-704-4829
Mailing Address - Fax:
Practice Address - Street 1:110 DAWN RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:08848-1134
Practice Address - Country:US
Practice Address - Phone:908-347-1290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No347C00000XTransportation ServicesPrivate Vehicle