Provider Demographics
NPI:1023445988
Name:SUMMIT PROFESSIONAL PLACEMENTS, INC.
Entity type:Organization
Organization Name:SUMMIT PROFESSIONAL PLACEMENTS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:LEDENILA
Authorized Official - Middle Name:TAGO
Authorized Official - Last Name:FONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-815-5190
Mailing Address - Street 1:11165 US HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1547
Mailing Address - Country:US
Mailing Address - Phone:269-815-5190
Mailing Address - Fax:269-815-5281
Practice Address - Street 1:11165 US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-1547
Practice Address - Country:US
Practice Address - Phone:269-815-5190
Practice Address - Fax:269-815-5281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS110299000311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility