=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538464763
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUMMIT CARE AND WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2011
-----------------------------------------------------
Last Update Date | 01/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 S. 24TH STREET
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-435-2273
-----------------------------------------------------
Fax | 402-435-2274
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1700 S 24TH ST
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68502-3056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-435-2273
-----------------------------------------------------
Fax | 402-435-2274
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. NANETTE GINGERY
-----------------------------------------------------
Credential | LMHP LPC LADC
-----------------------------------------------------
Telephone | 402-435-2273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | 669
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------