Provider Demographics
NPI:1417368622
Name:SOUTHSIDE ACADEMY, INC.
Entity Type:Organization
Organization Name:SOUTHSIDE ACADEMY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-719-1199
Mailing Address - Street 1:1833 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44507-1137
Mailing Address - Country:US
Mailing Address - Phone:330-742-9090
Mailing Address - Fax:
Practice Address - Street 1:1833 MARKET ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44507-1137
Practice Address - Country:US
Practice Address - Phone:330-742-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)