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General NPI Number Information
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NPI Number | 1174203335
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Entity Type | Organization
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Legal Business Name | SUMMIT INTEGRATED SERVICES LLC
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 4205 LANCASTER LN N STE 100
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City | PLYMOUTH
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State | MN
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Zip | 55441-1702
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Country | US
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Telephone | 612-600-4575
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Fax |
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Provider Business Mailing Address
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Address Line | 7101 YORK AVE S # 357
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City | EDINA
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State | MN
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Zip | 55435-2292
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Country | US
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Telephone | 612-564-9816
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ASAD HASSAN
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Credential |
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Telephone | 952-737-2130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State |
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