Provider Demographics
NPI:1871333740
Name:SIDE BY SIDE MINISTRIES LLC
Entity type:Organization
Organization Name:SIDE BY SIDE MINISTRIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LONGCOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:317-203-9667
Mailing Address - Street 1:6480 E COAL BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-9688
Mailing Address - Country:US
Mailing Address - Phone:317-203-9667
Mailing Address - Fax:
Practice Address - Street 1:2680 E MAIN ST STE 333
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2825
Practice Address - Country:US
Practice Address - Phone:317-203-9667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty