Healthcare Provider Details

I. General information

NPI: 1790550598
Provider Name (Legal Business Name): SUMMIT COMMUNITY HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5008 EDMONDSON AVE
BALTIMORE MD
21229-2332
US

IV. Provider business mailing address

5008 EDMONDSON AVE
BALTIMORE MD
21229-2332
US

V. Phone/Fax

Practice location:
  • Phone: 410-246-1508
  • Fax: 113-471-8785
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHRISTINA L KUEHNE
Title or Position: DIRECTOR OF PROGRAMS
Credential: LMSW
Phone: 410-961-1866