Provider Demographics
NPI:1235532060
Name:SUCCESSFUL LIVINGS LLC
Entity Type:Organization
Organization Name:SUCCESSFUL LIVINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:LEMONT
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:480-560-8924
Mailing Address - Street 1:304 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4634
Mailing Address - Country:US
Mailing Address - Phone:480-560-8924
Mailing Address - Fax:
Practice Address - Street 1:304 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4634
Practice Address - Country:US
Practice Address - Phone:480-560-8924
Practice Address - Fax:520-350-1790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-4483322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children