Organization
WESTSIDE SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY J CONRAD (OWNER OPERATOR)
(740) 689-0963
Entity
Organization
Contact information
Practice address
639 BRUMFIELD RD, LANCASTER, OH 43130-2801
(740) 689-0963
(740) 689-0971
Mailing address
639 BRUMFIELD RD, LANCASTER, OH 43130-2801
(740) 689-0963
(740) 689-0971
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
251C00000X
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
053024742801
—
OH
05
—
103426545299
—
OH
05
—
105281184999
—
OH
05
—
106605966699
—
OH
05
—
107324031799
—
OH
05
—
231007893201
—
OH
05
—
231011069301
—
OH
05
—
413004901001
—
OH
Enumeration date
04/10/2007
Last updated
08/22/2020
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