Healthcare Provider Details

I. General information

NPI: 1477312221
Provider Name (Legal Business Name): BY YOUR SIDE AZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S COMSTOCK AVE
SUTHERLIN OR
97479-9409
US

IV. Provider business mailing address

130 S COMSTOCK AVE
SUTHERLIN OR
97479-9409
US

V. Phone/Fax

Practice location:
  • Phone: 541-459-1260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE SHAW
Title or Position: MEMBER
Credential:
Phone: 541-459-1260