NPIMap

Organization Active NPI

Westside Support Services LLC

  • Developmentally Disabled Services Day Training Agency
  • Lancaster, OH
National Provider Identifier
1710100979
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
License
251C00000X Issued in OH
Legal business name
WESTSIDE SUPPORT SERVICES LLC
Practice address
639 Brumfield Rd
Lancaster, OH 43130-2801
Phone
(740) 689-0963
Fax
(740) 689-0971
NPI assigned
Apr 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kimberly J Conrad
Title
Owner Operator
Phone
(740) 689-0963

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X 251C00000X OH Primary

Addresses

Primary practice location

639 Brumfield Rd
Lancaster, OH 43130-2801

Mailing address

639 Brumfield Rd
Lancaster, OH 43130-2801
Phone (740) 689-0963

Other identifiers 8

IdentifierTypeStateIssuer
105281184999MedicaidOH
106605966699MedicaidOH
103426545299MedicaidOH
107324031799MedicaidOH
231011069301MedicaidOH
413004901001MedicaidOH
231007893201MedicaidOH
053024742801MedicaidOH

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710100979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "639 BRUMFIELD RD",
            "city": "LANCASTER",
            "state": "OH",
            "postal_code": "431302801",
            "telephone_number": "740-689-0963",
            "fax_number": "740-689-0971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "639 BRUMFIELD RD",
            "city": "LANCASTER",
            "state": "OH",
            "postal_code": "431302801",
            "telephone_number": "740-689-0963",
            "fax_number": "740-689-0971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTSIDE SUPPORT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CONRAD",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER  OPERATOR",
        "authorized_official_telephone_number": "740-689-0963"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "OH",
            "license": "251C00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105281184999",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106605966699",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103426545299",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107324031799",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "231011069301",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "413004901001",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "231007893201",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "053024742801",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.