MEDICARE: SUCCESS IS YOURS INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center	16-001	MD

General Provider Information

NPI Number	:	1104151935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUCCESS IS YOURS INC.

Provider Business Mailing Address
First Line	:	3601 TAYLOR ST
Second Line	:
City	:	BRENTWOOD
State	:	MD
Zip	:	20722-1300
Country	:	US
Telephone Number	:	301-699-0850
Fax Number	:	301-699-0851

Provider Business Practice Location Address
First Line	:	3601 TAYLOR ST
Second Line	:
City	:	BRENTWOOD
State	:	MD
Zip	:	20722-1300
Country	:	US
Telephone Number	:	301-699-0850
Fax Number	:	301-699-0851

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	STEPHON SMITH
Credential	:
Telephone Number	:	301-821-2650

Provider Enumeration Date	:	10/13/2009
Last Update Date	:	10/13/2009

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Directions to “SUCCESS IS YOURS INC. ” Practice Location

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