MEDICARE: SOLEDAD SOCIAL SERVICES CORPORATION

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	253Z00000X	In Home Supportive Care Agency	200900006C	IL

General Provider Information

NPI Number	:	1942651013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLEDAD SOCIAL SERVICES CORPORATION

Provider Business Mailing Address
First Line	:	7107 W BELMONT AVE STE 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4500
Country	:	US
Telephone Number	:	773-481-9096
Fax Number	:	773-622-8385

Provider Business Practice Location Address
First Line	:	7107 W BELMONT AVE STE 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4500
Country	:	US
Telephone Number	:	773-481-9096
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	EDDIE FUTOTANA
Credential	:
Telephone Number	:	773-706-9308

Provider Enumeration Date	:	06/29/2016
Last Update Date	:	06/29/2016

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Directions to “SOLEDAD SOCIAL SERVICES CORPORATION ” Practice Location

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