Provider Demographics
NPI:1528504115
Name:SUMMIT BHC SACRAMENTO, LLC
Entity type:Organization
Organization Name:SUMMIT BHC SACRAMENTO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-716-4924
Mailing Address - Street 1:2221 FAIR OAKS BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825
Mailing Address - Country:US
Mailing Address - Phone:916-514-8500
Mailing Address - Fax:916-923-1900
Practice Address - Street 1:10587 DOUBLE R BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5868
Practice Address - Country:US
Practice Address - Phone:916-514-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1386066322OtherNPI