MEDICARE: QUALITY SUCCESS SERVICES

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
2	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1952064503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY SUCCESS SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 295
Second Line	:
City	:	WAYLAND
State	:	KY
Zip	:	41666-0295
Country	:	US
Telephone Number	:	606-259-3749
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 S LAKE DR STE 204
Second Line	:
City	:	PRESTONSBURG
State	:	KY
Zip	:	41653-1903
Country	:	US
Telephone Number	:	606-259-3749
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CHARLA ANN HOPKINS
Credential	:
Telephone Number	:	606-259-3749

Provider Enumeration Date	:	10/20/2021
Last Update Date	:	04/27/2023

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Directions to “QUALITY SUCCESS SERVICES ” Practice Location

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