Provider Demographics
NPI:1275386021
Name:SUMMIT YOUTH ACADEMY, INC
Entity Type:Organization
Organization Name:SUMMIT YOUTH ACADEMY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:FEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-365-3642
Mailing Address - Street 1:330 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-3470
Mailing Address - Country:US
Mailing Address - Phone:208-365-3642
Mailing Address - Fax:208-365-3687
Practice Address - Street 1:330 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-3470
Practice Address - Country:US
Practice Address - Phone:208-365-3642
Practice Address - Fax:208-365-3687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children