Healthcare Provider Details

I. General information

NPI: 1386922201
Provider Name (Legal Business Name): A KEY TO SUCCESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 LAWRY RUN DR APT 201
CHARLOTTE NC
28273-3508
US

IV. Provider business mailing address

2215 LAWRY RUN DR APT 201
CHARLOTTE NC
28273-3508
US

V. Phone/Fax

Practice location:
  • Phone: 704-236-1377
  • Fax:
Mailing address:
  • Phone: 704-236-1377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNC

VIII. Authorized Official

Name: MISS PAMELA ANNETTE FULLER
Title or Position: OWNER/ EXECUTIVE DIRECTOR
Credential:
Phone: 704-236-1377