Healthcare Provider Details

I. General information

NPI: 1023483559
Provider Name (Legal Business Name): SOUTH CHICAGO PARENTS AND FRIENDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10241 S COMMERCIAL AVE
CHICAGO IL
60617-5835
US

IV. Provider business mailing address

10241 S COMMERCIAL AVE
CHICAGO IL
60617-5835
US

V. Phone/Fax

Practice location:
  • Phone: 773-734-2222
  • Fax: 773-734-2850
Mailing address:
  • Phone: 773-734-2222
  • Fax: 773-734-2850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number199100087C
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS M SCHELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 773-734-2222