# SUCCESSFUL START LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518105642
- **Authorized official:** MR. KHALID TSALANI GREENAWAY (OWNER)
- **Authorized official phone:** (336) 253-5286

## Contact information

- **Practice address:** 2309 WILLIAMS AVE, HIGH POINT, NC 27262-3548
- **Practice address phone:** (336) 886-5611
- **Practice address fax:** (336) 886-5616
- **Mailing address:** PO BOX 13512, GREENSBORO, NC 27415-3512
- **Mailing address phone:** (336) 253-5286
- **Mailing address fax:** (336) 886-5616

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251S00000X | Community/Behavioral Health Agency | MHL-041-888 | NC | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL-041-888 | NC | Yes |

## Other

- **Enumeration date:** 01/27/2009
- **Last updated:** 11/17/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 080665 | STATE OF NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES FACILITY ID | NC |
| 01 | — | MHL-041-888 | STATE OF NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES LICENSURE NUMBER | NC |