Organization
SIDE BY SIDE II, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA L WEISENBORN (PRESIDENT)
(816) 356-0923
Entity
Organization
Contact information
Practice address
6612 BLUE RIDGE BOULEVARD, A, RAYTOWN, MO 64133
(816) 356-0923
(816) 356-0925
Mailing address
6612 BLUE RIDGE BOULEVARD, A, RAYTOWN, MO 64133
(816) 356-0923
(816) 356-0925
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8558833401
—
MO
Enumeration date
12/07/2007
Last updated
12/07/2007
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