Healthcare Provider Details

I. General information

NPI: 1376275628
Provider Name (Legal Business Name): COMMUNITY SUCCESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WASHINGTON ST
PENSACOLA FL
32507-3600
US

IV. Provider business mailing address

16 WASHINGTON ST
PENSACOLA FL
32507-3600
US

V. Phone/Fax

Practice location:
  • Phone: 850-516-9437
  • Fax:
Mailing address:
  • Phone: 850-516-9437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHARON REED
Title or Position: SEC.
Credential:
Phone: 850-516-9437