Provider Demographics
NPI:1508982752
Name:SIDE BY SIDE II, INC.
Entity Type:Organization
Organization Name:SIDE BY SIDE II, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WEISENBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-729-7389
Mailing Address - Street 1:6612 BLUE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-4847
Mailing Address - Country:US
Mailing Address - Phone:816-356-0923
Mailing Address - Fax:
Practice Address - Street 1:6612 BLUE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-4847
Practice Address - Country:US
Practice Address - Phone:816-356-0923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO8002062Medicaid
MO8001199Medicaid
MO8001793Medicaid