Healthcare Provider Details

I. General information

NPI: 1548624695
Provider Name (Legal Business Name): SUMMIT HEALTHCARE ORGANIZATION - BAY AREA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39899 BALENTINE DR SUITE 314
NEWARK CA
94560-5366
US

IV. Provider business mailing address

39899 BALENTINE DR SUITE 314
NEWARK CA
94560-5366
US

V. Phone/Fax

Practice location:
  • Phone: 510-573-2415
  • Fax: 888-875-0832
Mailing address:
  • Phone: 510-573-2415
  • Fax: 888-875-0832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number550003065
License Number StateCA

VIII. Authorized Official

Name: JONATHAN BLISS
Title or Position: ADMINISTRATOR
Credential:
Phone: 408-609-0245