Provider Demographics
NPI:1710212543
Name:SUCCESS IS YOURS INC.
Entity Type:Organization
Organization Name:SUCCESS IS YOURS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHON
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-821-2650
Mailing Address - Street 1:6514 MARLBORO PIKE UNIT 47681
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20753-6531
Mailing Address - Country:US
Mailing Address - Phone:301-741-1316
Mailing Address - Fax:240-573-3521
Practice Address - Street 1:10845 LANHAM SEVERN RD
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9548
Practice Address - Country:US
Practice Address - Phone:301-741-1316
Practice Address - Fax:240-573-3521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16-002261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care