Provider Demographics
NPI:1629368808
Name:SCO FAMILY OF SERVICES
Entity Type:Organization
Organization Name:SCO FAMILY OF SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:CHARTESS
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-671-1253
Mailing Address - Street 1:100 TERRACE AVE
Mailing Address - Street 2:APT 101
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-2314
Mailing Address - Country:US
Mailing Address - Phone:516-234-9032
Mailing Address - Fax:
Practice Address - Street 1:1 ALEXANDER PL
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-3745
Practice Address - Country:US
Practice Address - Phone:516-671-1253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3045461322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children