=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497917371
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUMMIT ACHIEVEMENT OF STOW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2008
-----------------------------------------------------
Last Update Date | 06/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 69 DEER HILL RD
-----------------------------------------------------
City | STOW
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04037-3100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-697-2020
-----------------------------------------------------
Fax | 207-697-2021
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 69 DEER HILL RD
-----------------------------------------------------
City | STOW
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04037-3100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-697-2020
-----------------------------------------------------
Fax | 207-697-2021
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO, CLINICAL DIRECTOR
-----------------------------------------------------
Name | NICHOLAS ERNST
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 207-697-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 322D00000X
-----------------------------------------------------
Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
-----------------------------------------------------
License Number | 216716
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3245S0500X
-----------------------------------------------------
Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 216716
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------