1003921420 NPI number — GOOD SUCCESS CONSULTING GROUP, LLC

Table of content: (NPI 1003921420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003921420 NPI number — GOOD SUCCESS CONSULTING GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD SUCCESS CONSULTING GROUP, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GOOD SUCCESS CENTER
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003921420
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
454 S ANDERSON RD STE 311
Provider Second Line Business Mailing Address:
BTC 598
Provider Business Mailing Address City Name:
ROCK HILL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29730-3392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-242-0778
Provider Business Mailing Address Fax Number:
877-752-1347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
454 S ANDERSON RD STE 2
Provider Second Line Business Practice Location Address:
BTC 598
Provider Business Practice Location Address City Name:
ROCK HILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29730-3392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-242-0778
Provider Business Practice Location Address Fax Number:
877-752-1347
Provider Enumeration Date:
08/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SWEENEY
Authorized Official First Name:
C
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
PRESIDENT / EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
803-242-0778

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  OTP - 087 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OTP-087 . This is a "SCDHEC LICENSE NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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