Provider Demographics
NPI:1689840480
Name:SUCCESSFUL SYSTEMS, INC.
Entity Type:Organization
Organization Name:SUCCESSFUL SYSTEMS, INC.
Other - Org Name:COMMUNITY MENTORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:BS, SLC, SE
Authorized Official - Phone:407-740-7673
Mailing Address - Street 1:699 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4553
Mailing Address - Country:US
Mailing Address - Phone:407-740-7673
Mailing Address - Fax:407-875-0887
Practice Address - Street 1:699 CLAY ST
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4553
Practice Address - Country:US
Practice Address - Phone:407-740-7673
Practice Address - Fax:407-875-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL229205251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL674014696OtherMEDICAID WAIVER
FL674014698OtherMEDICAID WAIVER