Healthcare Provider Details

I. General information

NPI: 1326761651
Provider Name (Legal Business Name): WOMEN AT YOUR SIDE AND COMMUNITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 DAWN RD
MILFORD NJ
08848-1134
US

IV. Provider business mailing address

259 MERCER ST
PHILLIPSBURG NJ
08865-3132
US

V. Phone/Fax

Practice location:
  • Phone: 908-347-1290
  • Fax:
Mailing address:
  • Phone: 862-704-4829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: DR. VERNELL MACKIE
Title or Position: CO-OWNER
Credential: CPLC, CCTS, CDVS
Phone: 862-704-4829