Provider Demographics
NPI:1811539703
Name:SUMMIT INDEPENDENT LIVING CENTER INC
Entity Type:Organization
Organization Name:SUMMIT INDEPENDENT LIVING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:FELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-728-1630
Mailing Address - Street 1:700 SW HIGGINS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1489
Mailing Address - Country:US
Mailing Address - Phone:406-728-1630
Mailing Address - Fax:406-829-3309
Practice Address - Street 1:700 SW HIGGINS AVE STE 101
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1489
Practice Address - Country:US
Practice Address - Phone:406-728-1630
Practice Address - Fax:406-829-3309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty