Healthcare Provider Details

I. General information

NPI: 1306701404
Provider Name (Legal Business Name): SUCCESS AT HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4829 FOWLER AVE
EVERETT WA
98203-3215
US

IV. Provider business mailing address

24 CREIGHTON CT
MARTINSBURG WV
25404-7475
US

V. Phone/Fax

Practice location:
  • Phone: 206-484-4405
  • Fax:
Mailing address:
  • Phone: 360-778-9519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MRS. RALENE D VAUGHN
Title or Position: CLINICAL DIRECTOR & MANAGING MEMBER
Credential: RN, BSN
Phone: 206-484-4405