Provider Demographics
NPI:1104391648
Name:SUMMIT DETOX
Entity type:Organization
Organization Name:SUMMIT DETOX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING AND COLLECTIONS
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-237-5306
Mailing Address - Street 1:PO BOX 732138
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2138
Mailing Address - Country:US
Mailing Address - Phone:561-501-5260
Mailing Address - Fax:561-501-5263
Practice Address - Street 1:3330 S. FEDERAL HIGHWAY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435
Practice Address - Country:US
Practice Address - Phone:561-501-5260
Practice Address - Fax:561-501-5263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty