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General NPI Number Information
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NPI Number | 1295462984
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Entity Type | Organization
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Legal Business Name | NORTHSIDE FAMILY RESOURCES LLC
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 11/23/2025
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Provider Practice Location Address
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Address Line | 1917 W FINN PL
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City | MILWAUKEE
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State | WI
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Zip | 53206-2319
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Country | US
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Telephone | 414-208-4229
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Fax |
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Provider Business Mailing Address
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Address Line | 16625 CHERRY HILL DR
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City | BROOKFIELD
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State | WI
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Zip | 53005-2716
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Country | US
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Telephone | 414-553-4965
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Fax |
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Authorized Official
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Title or Position | MANAGER STUDENT
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Name | MS. DION HOLLINGSWORTH L
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Credential | STUDENT
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Telephone | 414-533-4965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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