1669689022 NPI number — SUCCESSFUL TRANSITIONS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669689022 NPI number — SUCCESSFUL TRANSITIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUCCESSFUL TRANSITIONS 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:
SUCCESSFUL TRANSITIONS LLC
Provider Other Organization Name Type Code:
3
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:
1669689022
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8300 CHARTWELL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK RIDGE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27310-9814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-312-3818
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1458 LONDON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27260-4263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-889-7500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WASHINGTON
Authorized Official First Name:
EVA
Authorized Official Middle Name:
LEWIS
Authorized Official Title or Position:
OWNER DIRECTOR
Authorized Official Telephone Number:
336-312-3818

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  MHL041818 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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