Healthcare Provider Details

I. General information

NPI: 1649420761
Provider Name (Legal Business Name): SUCCESS IN LIVING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 OLD JONESBORO RD
FAIRBURN GA
30213-3244
US

IV. Provider business mailing address

2621 OLD JONESBORO RD
FAIRBURN GA
30213-3244
US

V. Phone/Fax

Practice location:
  • Phone: 404-771-4993
  • Fax:
Mailing address:
  • Phone: 404-771-4993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. IDA HOWELL
Title or Position: PRESIDENT
Credential:
Phone: 404-771-4993