Healthcare Provider Details

I. General information

NPI: 1760324594
Provider Name (Legal Business Name): SUMMIT WELLNESS SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/12/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 BURGESS ST
MANCHESTER NH
03104-5325
US

IV. Provider business mailing address

118 BURGESS ST
MANCHESTER NH
03104-5325
US

V. Phone/Fax

Practice location:
  • Phone: 603-858-5032
  • Fax:
Mailing address:
  • Phone: 603-858-5032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA BENNETT
Title or Position: CEO
Credential:
Phone: 603-858-5032