Healthcare Provider Details

I. General information

NPI: 1033585492
Provider Name (Legal Business Name): SUMMIT SUPPORT SERVICES OF ASHE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 COURT STREET
JEFFERSON NC
28640
US

IV. Provider business mailing address

PO BOX 381
JEFFERSON NC
28640-0381
US

V. Phone/Fax

Practice location:
  • Phone: 336-846-3456
  • Fax: 336-846-6457
Mailing address:
  • Phone: 336-846-4491
  • Fax: 336-846-4927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL-005-018
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHARI ANDERSON ROGNSTAD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 336-846-4491