MEDICARE: SOUTH CENTRAL COMMUNITY SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1033389432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH CENTRAL COMMUNITY SERVICES, INC.

Provider Business Mailing Address
First Line	:	8316 S ELLIS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-5509
Country	:	US
Telephone Number	:	773-483-0900
Fax Number	:	773-483-8090

Provider Business Practice Location Address
First Line	:	8316 S ELLIS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-5509
Country	:	US
Telephone Number	:	773-483-0900
Fax Number	:	773-483-8090

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	JUDI BRADLEY
Credential	:
Telephone Number	:	773-483-0900

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	03/03/2008

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