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General NPI Number Information
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NPI Number | 1124154414
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Entity Type | Organization
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Legal Business Name | DOCKSIDE SERVICES INC.
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8695 CONNECTICUT ST STE B
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City | MERRILLVILLE BRA
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State | IN
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Zip | 46410-6387
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Country | US
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Telephone | 219-736-4817
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Fax | 219-736-4827
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Provider Business Mailing Address
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Address Line | 10304 SPOTSYLVANIA AVE STE 300
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-8602
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Country | US
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Telephone | 540-710-6085
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Fax | 540-710-6447
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. ELENA DWYRE
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Credential |
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Telephone | 219-736-4817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 370346298 53782
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License Number State | IN
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