Provider Demographics
NPI:1669617510
Name:SUMMIT CONTRACT THERAPY CENTER, LLC
Entity type:Organization
Organization Name:SUMMIT CONTRACT THERAPY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, LICENSED OTA
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:HOUSE
Authorized Official - Last Name:FRIEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:LOTA
Authorized Official - Phone:210-725-2229
Mailing Address - Street 1:2331 NW MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-2502
Mailing Address - Country:US
Mailing Address - Phone:210-617-7716
Mailing Address - Fax:210-617-7716
Practice Address - Street 1:2331 NW MILITARY HWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-2502
Practice Address - Country:US
Practice Address - Phone:210-617-7716
Practice Address - Fax:210-617-7716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-06
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
385H00000X
TX208277251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
208277OtherOTA LICENSE