MEDICARE: WAYS TO SUCCESS DEVELOPMEMT ,INC

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	3245S0500X	Children's Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1811263932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYS TO SUCCESS DEVELOPMEMT ,INC

Provider Business Mailing Address
First Line	:	4921 ALBEMARLE RD SUITE 203
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215
Country	:	US
Telephone Number	:	704-430-1776
Fax Number	:	704-431-3100

Provider Business Practice Location Address
First Line	:	4921 ALBEMARLE RD STE 203
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6654
Country	:	US
Telephone Number	:	704-430-1776
Fax Number	:	704-431-3100

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. KEYANNA N BODRICK
Credential	:	MASTER06/14/2009
Telephone Number	:	704-430-1776

Provider Enumeration Date	:	03/23/2012
Last Update Date	:	03/23/2012

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Directions to “WAYS TO SUCCESS DEVELOPMEMT ,INC ” Practice Location

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