Healthcare Provider Details

I. General information

NPI: 1912829987
Provider Name (Legal Business Name): SUCCESSWORKS 264 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 SADDLEHORSE LN
GREENSBORO NC
27405-9804
US

IV. Provider business mailing address

107 SADDLEHORSE LN
GREENSBORO NC
27405-9804
US

V. Phone/Fax

Practice location:
  • Phone: 336-332-9600
  • Fax:
Mailing address:
  • Phone: 336-332-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. SALENA EBOKPO
Title or Position: OWNER
Credential: LLC
Phone: 336-332-9600