Basic Information
| Provider Information | |||||||||
| NPI: | 1306308101 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMMIT SILVER CREEK, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2046 125 T AVE NW | ||||||||
| Address2: | |||||||||
| City: | WATFORD CITY | ||||||||
| State: | ND | ||||||||
| PostalCode: | 58854 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2046 125 T AVE NW | ||||||||
| Address2: | |||||||||
| City: | WATFORD CITY | ||||||||
| State: | ND | ||||||||
| PostalCode: | 58854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325801732 | ||||||||
| FaxNumber: | 7015973004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2019 | ||||||||
| LastUpdateDate: | 11/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | D'ALESSANDRO | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7325801732 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.