Organization
SUCCESSFUL START LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KHALID TSALANI GREENAWAY (OWNER)
(336) 253-5286
Entity
Organization
Contact information
Practice address
2309 WILLIAMS AVE, HIGH POINT, NC 27262-3548
(336) 886-5611
(336) 886-5616
Mailing address
PO BOX 13512, GREENSBORO, NC 27415-3512
(336) 253-5286
(336) 886-5616
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
MHL-041-888
NC
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-041-888
NC
Other
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
Enumeration date
01/27/2009
Last updated
11/17/2009
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