Provider Demographics
NPI:1093015083
Name:SUMMIT GUIDANCE, INC
Entity type:Organization
Organization Name:SUMMIT GUIDANCE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:M
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-348-8073
Mailing Address - Street 1:182 UNIVERSITY AVE N180
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-0053
Mailing Address - Country:US
Mailing Address - Phone:651-276-0607
Mailing Address - Fax:
Practice Address - Street 1:182 UNIVERSITY AVE N180
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6345
Practice Address - Country:US
Practice Address - Phone:651-276-0607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1104153881OtherMINNESOTA