Healthcare Provider Details

I. General information

NPI: 1164865499
Provider Name (Legal Business Name): BY YOUR SIDE - PEACE OF MIND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 S COMSTOCK
SUTHERLIN OR
97479
US

IV. Provider business mailing address

130 S COMSTOCK
SUTHERLIN OR
97479
US

V. Phone/Fax

Practice location:
  • Phone: 541-229-2273
  • Fax: 541-229-5265
Mailing address:
  • Phone: 541-459-1260
  • Fax: 541-459-9878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE R SHAW
Title or Position: MEMBER/MANAGER
Credential:
Phone: 541-229-2273