Provider Demographics
NPI:1811314503
Name:GOD'S SUCCESS RE-ENTRY RECOVERY SERVICES
Entity type:Organization
Organization Name:GOD'S SUCCESS RE-ENTRY RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KANDANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW/LICDC
Authorized Official - Phone:419-699-8759
Mailing Address - Street 1:815 ELYSIAN AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-3122
Mailing Address - Country:US
Mailing Address - Phone:419-699-8759
Mailing Address - Fax:
Practice Address - Street 1:1416 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-4101
Practice Address - Country:US
Practice Address - Phone:419-699-8759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health