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General NPI Number Information
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NPI Number | 1366967689
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Entity Type | Organization
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Legal Business Name | SUMMIT LEADERSHIP ACADEMY - HIGH DESERT
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Dates
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Enumeration Date | 08/08/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 12850 MUSCATEL ST
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City | HESPERIA
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State | CA
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Zip | 92344-5566
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Country | US
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Telephone | 760-949-0202
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Fax | 760-949-9257
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Provider Business Mailing Address
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Address Line | 12850 MUSCATEL ST
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City | HESPERIA
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State | CA
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Zip | 92344-5566
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Country | US
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Telephone | 760-949-0202
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Fax | 760-949-9257
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Authorized Official
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Title or Position | DIRECTOR, BUSINESS SERVICES
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Name | MISS DESIREE GARDNER
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Credential |
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Telephone | 760-949-9202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 36-75044
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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