Provider Demographics
NPI:1295462984
Name:NORTHSIDE FAMILY RESOURCES LLC
Entity type:Organization
Organization Name:NORTHSIDE FAMILY RESOURCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER STUDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DION
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINGSWORTH L
Authorized Official - Suffix:
Authorized Official - Credentials:STUDENT
Authorized Official - Phone:414-533-4965
Mailing Address - Street 1:16625 CHERRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2716
Mailing Address - Country:US
Mailing Address - Phone:414-553-4965
Mailing Address - Fax:
Practice Address - Street 1:327 E BROADWAY
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-5008
Practice Address - Country:US
Practice Address - Phone:262-665-3422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management