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General NPI Number Information
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NPI Number | 1891547626
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Entity Type | Organization
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Legal Business Name | RESIDENTIAL CARE AT THE SUMMIT, LLC
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Dates
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Enumeration Date | 04/04/2024
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 2501 E SEMINARY DR
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City | FORT WORTH
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State | TX
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Zip | 76119-5602
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Country | US
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Telephone | 817-882-6200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 15836
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City | FORT WORTH
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State | TX
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Zip | 76119-0836
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Country | US
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Telephone | 817-882-6200
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | LORI NOLEN
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Credential |
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Telephone | 682-472-2869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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