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Organization

SOARING ON SUCCESS, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. DWAYNE LEE GIBSON JR. (CEO)
(419) 705-8682
Entity
Organization

Contact information

Practice address
5001 SOUTH AVE LOT 55, TOLEDO, OH 43615-6445
(419) 705-8682
Mailing address
5001 SOUTH AVE LOT 55, TOLEDO, OH 43615-6445
(419) 705-8682

Taxonomy

Speciality
Code
Description
License number
State
174200000X
Meals Provider
251B00000X
Case Management Agency
251S00000X
Community/Behavioral Health Agency
Primary

Other

Enumeration date
10/17/2019
Last updated
10/17/2019
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