Healthcare Provider Details

I. General information

NPI: 1730095787
Provider Name (Legal Business Name): SUMMIT SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 BRACNH TPKE 60
CONCORD NH
03301
US

IV. Provider business mailing address

58 BRACNH TPKE 60
CONCORD NH
03301
US

V. Phone/Fax

Practice location:
  • Phone: 207-630-5305
  • Fax:
Mailing address:
  • Phone: 207-630-5305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHN SEBINEZA
Title or Position: MANAGING MEMBER
Credential:
Phone: 207-630-5305