Provider Demographics
NPI:1477150720
Name:SILVER SUMMIT SOUTH LLC
Entity Type:Organization
Organization Name:SILVER SUMMIT SOUTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-314-9676
Mailing Address - Street 1:3651 LINDELL RD STE D
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-1200
Mailing Address - Country:US
Mailing Address - Phone:562-314-9676
Mailing Address - Fax:
Practice Address - Street 1:3651 LINDELL RD STE D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-1200
Practice Address - Country:US
Practice Address - Phone:562-314-9676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health