Provider Demographics
NPI:1790479459
Name:C & C PEDIATRICS WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:C & C PEDIATRICS WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AKILAH
Authorized Official - Middle Name:LATISH
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-601-0890
Mailing Address - Street 1:22638 GRANITE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-8979
Mailing Address - Country:US
Mailing Address - Phone:708-601-0890
Mailing Address - Fax:815-717-7229
Practice Address - Street 1:1005 W LARAWAY RD STE 230
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-4117
Practice Address - Country:US
Practice Address - Phone:815-570-9303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center