=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760792816
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUMMIT LIFE SOLUTIONS I LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2010
-----------------------------------------------------
Last Update Date | 02/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10190 BANNOCK ST STE 230
-----------------------------------------------------
City | NORTHGLENN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80260-6083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-452-6500
-----------------------------------------------------
Fax | 303-452-6520
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10190 BANNOCK ST STE 230
-----------------------------------------------------
City | NORTHGLENN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80260-6083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-452-6500
-----------------------------------------------------
Fax | 303-452-6520
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING DIRECTOR
-----------------------------------------------------
Name | LORIN CHEVALIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-452-6500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 04L110
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------