MEDICARE: SCO FAMILY OF SERVICES

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	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1457650392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCO FAMILY OF SERVICES

Provider Business Mailing Address
First Line	:	1 ALEXANDER PL
Second Line	:
City	:	GLEN COVE
State	:	NY
Zip	:	11542-3745
Country	:	US
Telephone Number	:	516-759-1844
Fax Number	:	516-759-6921

Provider Business Practice Location Address
First Line	:	1250 E 229TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-5851
Country	:	US
Telephone Number	:	718-405-7060
Fax Number	:	718-405-6069

Authorized Official
Title or Position	:	CEO
Name	:	DOUGLAS O'DELL
Credential	:
Telephone Number	:	516-671-1253

Provider Enumeration Date	:	03/17/2011
Last Update Date	:	11/14/2014

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Directions to “SCO FAMILY OF SERVICES ” Practice Location

Language	Start Address	Practice Location

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