Healthcare Provider Details

I. General information

NPI: 1114843679
Provider Name (Legal Business Name): SUMMIT LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 34TH ST S APT 850
ST PETERSBURG FL
33711-4593
US

IV. Provider business mailing address

4341 34TH ST S APT 850
ST PETERSBURG FL
33711-4593
US

V. Phone/Fax

Practice location:
  • Phone: 845-325-6179
  • Fax:
Mailing address:
  • Phone: 845-325-6179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: THOMAS K PADDOCK
Title or Position: OWNER
Credential:
Phone: 845-325-6179