Healthcare Provider Details

I. General information

NPI: 1174203335
Provider Name (Legal Business Name): SUMMIT INTEGRATED SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 40TH AVE NE
COLUMBIA HEIGHTS MN
55421-3834
US

IV. Provider business mailing address

501 40TH AVE NE
COLUMBIA HEIGHTS MN
55421-3834
US

V. Phone/Fax

Practice location:
  • Phone: 612-600-4575
  • Fax: 612-486-8607
Mailing address:
  • Phone: 612-600-4575
  • Fax: 612-486-8607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: ASAD HASSAN
Title or Position: MANAGER
Credential:
Phone: 952-737-2130