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NPI Code Detail

MEDICARE: SUMMIT GUIDANCE, INC

MEDICARE: SUMMIT GUIDANCE, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11104153881OTHERMNMINNESOTA

General Provider Information

NPI Number : 1093015083
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUMMIT GUIDANCE, INC
Provider Business Mailing Address
First Line : 182 UNIVERSITY AVE N180
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-0053
Country : US
Telephone Number : 651-276-0607
Fax Number :
Provider Business Practice Location Address
First Line : 182 UNIVERSITY AVE N180
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-6345
Country : US
Telephone Number : 651-276-0607
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MR. AHMED M HASSAN
Credential :
Telephone Number : 651-348-8073
Provider Enumeration Date : 10/25/2010
Last Update Date : 12/11/2013

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Directions to “SUMMIT GUIDANCE, INC ” Practice Location

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