MEDICARE: SUMMIT BHC MESA LLC

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1881120558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT BHC MESA LLC

Provider Business Mailing Address
First Line	:	860 N CENTER ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-4201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	860 N CENTER ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-4201
Country	:	US
Telephone Number	:	877-463-3553
Fax Number	:

Authorized Official
Title or Position	:	GENERAL COUNSEL & SECRETARY
Name	:	JAMES STEPHEN HINKLE
Credential	:
Telephone Number	:	615-637-7218

Provider Enumeration Date	:	05/02/2017
Last Update Date	:	06/19/2026

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