Provider Demographics
NPI:1447624143
Name:SUMMIT ACADEMY MANAGEMENT
Entity type:Organization
Organization Name:SUMMIT ACADEMY MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:NICHOL
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:419-476-7859
Mailing Address - Street 1:2913 S. REPUBLIC BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1911
Mailing Address - Country:US
Mailing Address - Phone:419-476-7859
Mailing Address - Fax:419-476-7763
Practice Address - Street 1:2913 S REPUBLIC BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1911
Practice Address - Country:US
Practice Address - Phone:419-476-7859
Practice Address - Fax:419-476-7763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1450770251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health