Healthcare Provider Details

I. General information

NPI: 1104391648
Provider Name (Legal Business Name): SUMMIT DETOX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 S. FEDERAL HIGHWAY 3RD FLOOR
BOYNTON BEACH FL
33435
US

IV. Provider business mailing address

PO BOX 732138
DALLAS TX
75373-2138
US

V. Phone/Fax

Practice location:
  • Phone: 561-501-5260
  • Fax: 561-501-5263
Mailing address:
  • Phone: 561-501-5260
  • Fax: 561-501-5263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS HASSON
Title or Position: DIRECTOR OF BILLING AND COLLECTIONS
Credential:
Phone: 561-237-5306