Provider Demographics
NPI:1225481260
Name:GWENDOLYN MCLEOD
Entity Type:Organization
Organization Name:GWENDOLYN MCLEOD
Other - Org Name:SUCCESSFUL SOLUTIONS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-940-1632
Mailing Address - Street 1:PO BOX 3852
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34948-3852
Mailing Address - Country:US
Mailing Address - Phone:772-940-1632
Mailing Address - Fax:
Practice Address - Street 1:3015 W DIXIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34946-1708
Practice Address - Country:US
Practice Address - Phone:772-940-1632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEAHCA013ZMedicaid