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General NPI Number Information
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NPI Number | 1881791168
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Entity Type | Organization
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Legal Business Name | SUMMER SKY, INC.
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/08/2012
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Provider Practice Location Address
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Address Line | 1100 N. MCCART STREET
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City | STEPHENVILLE
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State | TX
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Zip | 76401-2430
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Country | US
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Telephone | 254-968-2907
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Fax | 254-968-4509
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Provider Business Mailing Address
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Address Line | 1100 N. MCCART STREET
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City | STEPHENVILLE
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State | TX
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Zip | 76401-2430
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Country | US
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Telephone | 254-968-2907
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Fax | 254-968-4509
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SCOTT KELLEY
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Credential | LCDC
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Telephone | 254-968-2907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 179-A
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License Number State | TX
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