Provider Demographics
NPI:1225815285
Name:SUMMIT SPRINGS WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:SUMMIT SPRINGS WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-822-9293
Mailing Address - Street 1:6161 BUSCH BLVD STE 200-201
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2508
Mailing Address - Country:US
Mailing Address - Phone:380-203-2886
Mailing Address - Fax:380-203-2752
Practice Address - Street 1:6161 BUSCH BLVD STE 200-201
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2508
Practice Address - Country:US
Practice Address - Phone:614-468-1222
Practice Address - Fax:614-468-1255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0032196Medicaid