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General NPI Number Information
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NPI Number | 1306701404
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Entity Type | Organization
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Legal Business Name | SUCCESS AT HOME, LLC
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Dates
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Enumeration Date | 12/19/2025
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 4829 FOWLER AVE
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City | EVERETT
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State | WA
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Zip | 98203-3215
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Country | US
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Telephone | 206-484-4405
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Fax |
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Provider Business Mailing Address
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Address Line | 24 CREIGHTON CT
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City | MARTINSBURG
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State | WV
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Zip | 25404-7475
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Country | US
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Telephone | 360-778-9519
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR & MANAGING MEMBER
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Name | MRS. RALENE D VAUGHN
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Credential | RN, BSN
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Telephone | 206-484-4405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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