Provider Demographics
NPI:1942462841
Name:SUCCESS FOR ALL OF FLORIDA, INC.
Entity Type:Organization
Organization Name:SUCCESS FOR ALL OF FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SILAS
Authorized Official - Middle Name:SWAYNE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-299-0006
Mailing Address - Street 1:PO BOX 2433
Mailing Address - Street 2:
Mailing Address - City:EATON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33840-2433
Mailing Address - Country:US
Mailing Address - Phone:863-640-9170
Mailing Address - Fax:
Practice Address - Street 1:111 AVENUE R NE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-2472
Practice Address - Country:US
Practice Address - Phone:863-299-0006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686101798OtherMEDICAID WAIVER
FL686101796OtherMEDICAID WAIVER