Healthcare Provider Details

I. General information

NPI: 1295462984
Provider Name (Legal Business Name): NORTHSIDE FAMILY RESOURCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 11/23/2025
Certification Date: 11/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1917 W FINN PL
MILWAUKEE WI
53206-2319
US

IV. Provider business mailing address

16625 CHERRY HILL DR
BROOKFIELD WI
53005-2716
US

V. Phone/Fax

Practice location:
  • Phone: 414-208-4229
  • Fax:
Mailing address:
  • Phone: 414-553-4965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. DION HOLLINGSWORTH L
Title or Position: MANAGER STUDENT
Credential: STUDENT
Phone: 414-533-4965