1124201637 NPI number — SUMMIT TREATMENT SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124201637 NPI number — SUMMIT TREATMENT SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMIT TREATMENT SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124201637
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17060 W 64TH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARVADA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80007-6823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-717-1765
Provider Business Mailing Address Fax Number:
303-424-9351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 LOGAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STERLING
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80751-2408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-522-7534
Provider Business Practice Location Address Fax Number:
970-522-7080
Provider Enumeration Date:
12/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THIELE
Authorized Official First Name:
JAROD
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
303-717-1765

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  1547948 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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