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General NPI Number Information
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NPI Number | 1023445988
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Entity Type | Organization
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Legal Business Name | SUMMIT PROFESSIONAL PLACEMENTS, INC.
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Dates
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Enumeration Date | 10/08/2013
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Last Update Date | 10/08/2013
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Provider Practice Location Address
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Address Line | 11165 US HIGHWAY 31
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City | BERRIEN SPRINGS
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State | MI
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Zip | 49103-1547
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Country | US
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Telephone | 269-815-5190
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Fax | 269-815-5281
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Provider Business Mailing Address
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Address Line | 11165 US HIGHWAY 31
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City | BERRIEN SPRINGS
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State | MI
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Zip | 49103-1547
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Country | US
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Telephone | 269-815-5190
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Fax | 269-815-5281
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Authorized Official
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Title or Position | PRESIDENT/SECRETARY
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Name | LEDENILA TAGO FONNER
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Credential |
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Telephone | 269-815-5190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | AS110299000
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License Number State | MI
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