Success Arena Home Health and Social Services

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

SUCCESS ARENA HOME HEALTH AND SOCIAL SERVICES

Practice address

13003 Packard St NE
Blaine, MN 55449-2204

Phone

(952) 818-4363

NPI assigned

Apr 30, 2024

Last updated

Apr 30, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bolaniran Oyeneyin

Title

Director

Phone

(952) 818-4363

Specialties & licenses 1

Addresses

Tax ID family

Success Arena Home Health2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Success Arena Home Health and Social Services

  dba Success Arena Home Health

  • Home Health Agency
  • Blaine, MN
  • NPI 1811887599
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714435200000",
    "number": "1942056858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13003 PACKARD ST NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554492204",
            "telephone_number": "952-818-4363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13003 PACKARD ST NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554492204",
            "telephone_number": "952-818-4363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUCCESS ARENA HOME HEALTH AND SOCIAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-30",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A",
        "authorized_official_last_name": "OYENEYIN",
        "authorized_official_first_name": "BOLANIRAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "952-818-4363"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John W Stoulil, PAC
• Kimberly Stubblefield, MA, LPCC
• Ann Studniski
• Jeffrey Michael Styba, D.C.
• Success Arena Home Health and Social Services (Success Arena Home Health)
• Samira Sugule, MD
• Lynn Alan Sulerud, O.D.
• Summit Orthopedics, LTD
• Superior Medical Services Inc
• Supervalu Pharmacies Inc (Cub Pharmacy)

• Adult Mental Health Clinic/Center in Blaine, MN
• Providers in Blaine, MN by specialty
• Adult Mental Health Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.