Provider Demographics
NPI:1932350469
Name:J & L SUMMERVILLE ACADEMY
Entity Type:Organization
Organization Name:J & L SUMMERVILLE ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-230-2689
Mailing Address - Street 1:618 NE TARBORO ST
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:CA
Mailing Address - Zip Code:27893
Mailing Address - Country:US
Mailing Address - Phone:252-230-2689
Mailing Address - Fax:
Practice Address - Street 1:618 NE TARBORO ST
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-230-2689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization