Healthcare Provider Details

I. General information

NPI: 1881922011
Provider Name (Legal Business Name): S&C ENTERPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17842 PARK AVE
LANSING IL
60438-1937
US

IV. Provider business mailing address

17842 PARK AVE
LANSING IL
60438-1937
US

V. Phone/Fax

Practice location:
  • Phone: 708-474-8433
  • Fax:
Mailing address:
  • Phone: 708-474-8433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CLYDE PAYNE III
Title or Position: DIRECTOR
Credential:
Phone: 708-474-8433