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General NPI Number Information
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NPI Number | 1326935370
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Entity Type | Organization
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Legal Business Name | SUMMIT REENTRY LLC
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 563 38TH AVE NE
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City | COLUMBIA HEIGHTS
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State | MN
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Zip | 55421-3802
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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 | 563 38TH AVE NE
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City | COLUMBIA HEIGHTS
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State | MN
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Zip | 55421-3802
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Country | US
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Telephone | 612-600-4575
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ASAD AHMED 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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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