=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811436645
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BY YOUR SIDE CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2017
-----------------------------------------------------
Last Update Date | 02/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6790 OLDE DAVENPORT RD
-----------------------------------------------------
City | LAMOTTE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-590-2688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6790 OLDE DAVENPORT RD
-----------------------------------------------------
City | LA MOTTE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52054-9525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-590-2688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. LISA FLANAGAN
-----------------------------------------------------
Credential | REGISTERED NURSE
-----------------------------------------------------
Telephone | 563-590-2688
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 090942
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number | 090942
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 090942
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------