Healthcare Provider Details

I. General information

NPI: 1205587458
Provider Name (Legal Business Name): SCCL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1363 VALLEY VIEW ROAD
DUNWOODY GA
30338
US

IV. Provider business mailing address

1363 VALLEY VIEW RD
DUNWOODY GA
30338-4822
US

V. Phone/Fax

Practice location:
  • Phone: 678-769-2929
  • Fax:
Mailing address:
  • Phone: 678-769-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LUCAS FORNASINI
Title or Position: OWNER
Credential:
Phone: 678-769-2929