Provider Demographics
NPI:1124062971
Name:SUMMER COMPUTER CAMP FOR DISADVANTAGED YOUTH
Entity type:Organization
Organization Name:SUMMER COMPUTER CAMP FOR DISADVANTAGED YOUTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-615-0287
Mailing Address - Street 1:15303 RIPPLEWIND LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-2035
Mailing Address - Country:US
Mailing Address - Phone:281-615-0287
Mailing Address - Fax:
Practice Address - Street 1:15303 RIPPLEWIND LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-2035
Practice Address - Country:US
Practice Address - Phone:281-615-0287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies