Provider Demographics
NPI:1124620133
Name:SIDE BY SIDE SERVICES LLC
Entity type:Organization
Organization Name:SIDE BY SIDE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SPADAFINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-607-3170
Mailing Address - Street 1:3893 LAKE VISTA RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44319-2656
Mailing Address - Country:US
Mailing Address - Phone:330-607-3170
Mailing Address - Fax:
Practice Address - Street 1:556 5TH ST NE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-2752
Practice Address - Country:US
Practice Address - Phone:330-607-3170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0210865Medicaid