=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255742953
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | S & C LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2014
-----------------------------------------------------
Last Update Date | 05/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2210 W WABANSIA AVE UNIT 301
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60647-5477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-248-5511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4957 OAKTON ST SUITE 272
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60077-2903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-248-5511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER/CO-OWNER
-----------------------------------------------------
Name | MRS. CAROLYN M LOSCUITO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-771-0608
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 3001022
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------