Provider Demographics
NPI:1194969287
Name:SUMMIT HEALTHCARE, INC
Entity type:Organization
Organization Name:SUMMIT HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:AFORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-721-7776
Mailing Address - Street 1:3018 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2001
Mailing Address - Country:US
Mailing Address - Phone:612-721-7776
Mailing Address - Fax:
Practice Address - Street 1:3018 E LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-2001
Practice Address - Country:US
Practice Address - Phone:612-721-7776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN013519400Medicaid