Provider Demographics
NPI:1336470392
Name:SOUTH CENTRAL COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:SOUTH CENTRAL COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:BLASINGAME
Authorized Official - Suffix:
Authorized Official - Credentials:ED D
Authorized Official - Phone:773-483-0900
Mailing Address - Street 1:8316 S ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-5509
Mailing Address - Country:US
Mailing Address - Phone:773-483-0900
Mailing Address - Fax:773-483-6161
Practice Address - Street 1:8445 S COTTAGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6113
Practice Address - Country:US
Practice Address - Phone:773-651-6448
Practice Address - Fax:773-651-6449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health