MEDICARE: SUCCESSFUL TRANSITIONS LLC

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	MHL041818	NC

General Provider Information

NPI Number	:	1669689022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUCCESSFUL TRANSITIONS LLC

Provider Business Mailing Address
First Line	:	8300 CHARTWELL DR
Second Line	:
City	:	OAK RIDGE
State	:	NC
Zip	:	27310-9814
Country	:	US
Telephone Number	:	336-707-6394
Fax Number	:

Provider Business Practice Location Address
First Line	:	1458 LONDON DR
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27260-4263
Country	:	US
Telephone Number	:	336-889-7500
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	VICTOR R WASHINGTON
Credential	:	MBA
Telephone Number	:	336-707-6394

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	12/09/2025

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