Summit Behavioral Health of Az, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

SUMMIT BEHAVIORAL HEALTH OF AZ, LLC

Practice address

1989 Willow Lake Rd Unit 100-105
Prescott, AZ 86301-4885

Phone

(928) 756-0694

Fax

(928) 708-9620

NPI assigned

May 7, 2020

Organization subpart

Yes

Parent organization

SUMMIT BEHAVIORAL HEALTH OF AZ, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Benjamin T Isenberg

Title

Ceo

Phone

(928) 710-7021

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Summit Behavioral Health of Az LLC3 organizations share this tax ID, including this one

Part of

Summit Behavioral Health of Az LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Summit Behavioral Health of Arizona

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Prescott Valley, AZ
  • NPI 1023471646
  NPD tax ID
• Summit Behavioral Health of Arizona

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Prescott Valley, AZ
  • NPI 1669002903
  NPD tax ID

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sheila Kaye Busch, FNP-C

  • Family Nurse Practitioner
  • Prescott, AZ
  • NPI 1619445814
  NPD (past)
• Shay Shapiro, LPC

  • Mental Health Counselor
  • Glendale, AZ
  • NPI 1851569727
  NPD (past)
• Greg Struve, LPC

  • Professional Counselor
  • Wickenburg, AZ
  • NPI 1598316739
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588809600000",
    "number": "1356963839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8183 E FLORENTINE RD",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863148481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1989 WILLOW LAKE RD UNIT 100-105",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863014885",
            "telephone_number": "928-756-0694",
            "fax_number": "928-708-9620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT BEHAVIORAL HEALTH OF AZ, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUMMIT BEHAVIORAL HEALTH OF AZ, LLC",
        "enumeration_date": "2020-05-07",
        "last_updated": "2020-05-07",
        "certification_date": "2020-05-07",
        "status": "A",
        "authorized_official_last_name": "ISENBERG",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "928-710-7021"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Lynn Sullivan
• Matthew Ryan Sullivan, OD
• Sulltrop Family Chiropractic PC
• Donald Craig Sulltrop, DC
• Julia Lynn Summers, LPC-12236
• Sun Hospice Inc
• Sunny Lee Nutrition, LLC
• Susan B Kullman LTD
• Conchita Dolores Sutherland, LMT
• Linda L Sutherland, LPC

• Substance Abuse Rehabilitation Facility in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Substance Abuse Rehabilitation Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.