Provider Demographics
NPI:1376760983
Name:SUMMIT HOME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:SUMMIT HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:480-366-5782
Mailing Address - Street 1:60 E RIO SALADO PKWY
Mailing Address - Street 2:STE 9057
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-9102
Mailing Address - Country:US
Mailing Address - Phone:480-366-5782
Mailing Address - Fax:
Practice Address - Street 1:60 E RIO SALADO PKWY
Practice Address - Street 2:STE 9057
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-9102
Practice Address - Country:US
Practice Address - Phone:480-366-5782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UNDER PROCESS251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ000000Medicare ID - Type UnspecifiedUNDER PROCESS