Provider Demographics
NPI:1295430858
Name:BY YOUR SIDE SENIOR CARE
Entity type:Organization
Organization Name:BY YOUR SIDE SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BLEDSOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-579-3059
Mailing Address - Street 1:1515 BUSINESS CENTER DR STE 3
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4401
Mailing Address - Country:US
Mailing Address - Phone:904-579-3059
Mailing Address - Fax:904-644-7972
Practice Address - Street 1:1515 BUSINESS CENTER DR STE 3
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4401
Practice Address - Country:US
Practice Address - Phone:904-579-3059
Practice Address - Fax:904-644-7972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health