Healthcare Provider Details

I. General information

NPI: 1023510716
Provider Name (Legal Business Name): BY YOUR SIDE HOME CARE SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 LAFAYETTE ST STE 3
MARIANNA FL
32446-3312
US

IV. Provider business mailing address

4425 LAFAYETTE ST STE 3
MARIANNA FL
32446-3312
US

V. Phone/Fax

Practice location:
  • Phone: 850-372-4883
  • Fax:
Mailing address:
  • Phone: 850-372-4883
  • Fax: 850-331-1583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: ALESHA PATTON PRIDGEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 850-372-4883