Provider Demographics
NPI:1033682943
Name:SUCCESS ADULT DAY HEALTH CARE CENTER
Entity Type:Organization
Organization Name:SUCCESS ADULT DAY HEALTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARDOSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-655-7375
Mailing Address - Street 1:211 N THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-6519
Mailing Address - Country:US
Mailing Address - Phone:318-655-7375
Mailing Address - Fax:
Practice Address - Street 1:211 N THOMAS DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-6519
Practice Address - Country:US
Practice Address - Phone:318-655-7375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care