Provider Demographics
NPI:1134487556
Name:SUMMIT SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:SUMMIT SENIOR LIVING, LLC
Other - Org Name:SUMMIT HILL SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-454-4801
Mailing Address - Street 1:2285 WATERS DR
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1363
Mailing Address - Country:US
Mailing Address - Phone:651-451-4446
Mailing Address - Fax:
Practice Address - Street 1:1870 OLD HUDSON RD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-4307
Practice Address - Country:US
Practice Address - Phone:651-451-4446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances