Provider Demographics
NPI:1891581757
Name:SUMMIT HOMECARE LLC
Entity type:Organization
Organization Name:SUMMIT HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGPANNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-478-3315
Mailing Address - Street 1:3300 SW 9TH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-7666
Mailing Address - Country:US
Mailing Address - Phone:515-478-3315
Mailing Address - Fax:
Practice Address - Street 1:3300 SW 9TH ST STE 6
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-7666
Practice Address - Country:US
Practice Address - Phone:515-478-3315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care