Provider Demographics
NPI:1619385333
Name:SIDEKICKS RESPITE CARE LLC
Entity Type:Organization
Organization Name:SIDEKICKS RESPITE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:ANTONELLOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-500-6686
Mailing Address - Street 1:2452 KUSER RD STE C
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3360
Mailing Address - Country:US
Mailing Address - Phone:609-500-6686
Mailing Address - Fax:
Practice Address - Street 1:2452 KUSER RD STE C
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3360
Practice Address - Country:US
Practice Address - Phone:609-500-6686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty