MEDICARE: SUMMIT HEALTHCARE, 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
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194969287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT HEALTHCARE, INC

Provider Business Mailing Address
First Line	:	3018 E LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-2001
Country	:	US
Telephone Number	:	612-721-7776
Fax Number	:

Provider Business Practice Location Address
First Line	:	3018 E LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-2001
Country	:	US
Telephone Number	:	612-721-7776
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MAXWELL AFORO
Credential	:
Telephone Number	:	612-721-7776

Provider Enumeration Date	:	04/21/2009
Last Update Date	:	04/21/2009

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