Healthcare Provider Details

I. General information

NPI: 1780548230
Provider Name (Legal Business Name): ACHIEVE GREATNESS ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 BRUMBAUGH AVE
NEW LEBANON OH
45345-1206
US

IV. Provider business mailing address

36 BRUMBAUGH AVE
NEW LEBANON OH
45345-1206
US

V. Phone/Fax

Practice location:
  • Phone: 937-216-9030
  • Fax: 937-716-2176
Mailing address:
  • Phone: 937-216-9030
  • Fax: 937-716-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RANDALL MICHAEL CARMACK
Title or Position: OWNER
Credential: LISW, LICDC
Phone: 937-216-9030