Organization
WESTSIDE GROUP HOME, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ILIANA R STOKES (PSD)
(941) 794-5759
Entity
Organization
Contact information
Practice address
2602 43RD ST W, BRADENTON, FL 34209-6212
(941) 795-1084
(941) 792-0385
Mailing address
6304 1ST AVE W, BRADENTON, FL 34209-2331
(941) 794-5759
(941) 794-5759
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
3209000000X
FL
Other
Enumeration date
12/09/2010
Last updated
12/09/2010
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