Provider Demographics
NPI:1568795318
Name:THE SUCCESS CENTER
Entity Type:Organization
Organization Name:THE SUCCESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-474-7601
Mailing Address - Street 1:1955 BERNICE RD STE 1NW
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-6049
Mailing Address - Country:US
Mailing Address - Phone:708-474-7601
Mailing Address - Fax:708-474-7615
Practice Address - Street 1:1955 BERNICE RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-6016
Practice Address - Country:US
Practice Address - Phone:708-474-7601
Practice Address - Fax:708-474-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health