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Organization

STALLWORTH COMMUNITY SERVICES INC

Active
Other names
Successful Development Inc
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. JANELL LATRICE STALLWORTH MA (PRESIDENT EXECUTIVE DIRECTOR)
(941) 536-4449
Entity
Organization

Contact information

Practice address
304 26TH AVENUE EAST, BRADENTON, FL 34208
(941) 536-4449
(941) 355-8699
Mailing address
PO BOX 57, TALLEVAST, FL 34270
(941) 536-4449
(941) 355-8699

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
690209096
FL
Enumeration date
05/27/2008
Last updated
05/27/2008
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