Provider Demographics
NPI:1942590716
Name:CITYSIDE HEALTHCARE
Entity Type:Organization
Organization Name:CITYSIDE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-896-9966
Mailing Address - Street 1:5216 4TH AVENUE CIR E
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5621
Mailing Address - Country:US
Mailing Address - Phone:941-896-9966
Mailing Address - Fax:941-896-9965
Practice Address - Street 1:5216 4TH AVENUE CIR E
Practice Address - Street 2:SUITE 1
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5621
Practice Address - Country:US
Practice Address - Phone:941-896-9966
Practice Address - Fax:941-896-9965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health