Healthcare Provider Details

I. General information

NPI: 1467936161
Provider Name (Legal Business Name): SUCCESS CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MAXIMILIAN DR
WESLEY CHAPEL FL
33543-6555
US

IV. Provider business mailing address

23975 CAMPANIA PASS
LAND O LAKES FL
34639-5475
US

V. Phone/Fax

Practice location:
  • Phone: 813-850-4970
  • Fax: 813-991-5071
Mailing address:
  • Phone: 813-850-4970
  • Fax: 813-991-5071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: OLUMUYIWA SUNDAY ADEDOYIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 813-850-4970