Healthcare Provider Details

I. General information

NPI: 1154240851
Provider Name (Legal Business Name): SUMMIT PEAK RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 LEEDS RD
HANOVER MD
21076-1458
US

IV. Provider business mailing address

12 CRAIN HWY N
GLEN BURNIE MD
21061-3565
US

V. Phone/Fax

Practice location:
  • Phone: 410-766-6398
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MELISSA SHADE
Title or Position: DIRECTOR OF COMPLIANCE
Credential:
Phone: 443-517-8724