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General NPI Number Information
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NPI Number | 1841068467
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Entity Type | Organization
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Legal Business Name | THE SUMMIT SANCTUARY LLC
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Dates
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Enumeration Date | 12/13/2023
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 14919 E CAVEDALE DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85262-7899
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Country | US
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Telephone | 480-335-2859
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Fax |
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Provider Business Mailing Address
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Address Line | 14919 E CAVEDALE DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85262-7899
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Country | US
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Telephone | 480-335-2859
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL GOLDMAN
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Credential |
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Telephone | 480-335-2859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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