NPIMap

Organization Active NPI

Summit Leadership Academy - High Desert

  • Local Education Agency (LEA)
  • Hesperia, CA
National Provider Identifier
1366967689
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Local Education Agency (LEA)Taxonomy code 251300000X
Legal business name
SUMMIT LEADERSHIP ACADEMY - HIGH DESERT
Practice address
12850 Muscatel St
Hesperia, CA 92344-5566
Phone
(760) 949-0202
Fax
(760) 949-9257
NPI assigned
Aug 8, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Miss Desiree GardnerNPI 1386502045
Title
Director, Business Services
Phone
(760) 949-9202

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Local Education Agency (LEA) 251300000X Primary
Clinic/Center 261Q00000X 36-75044 CA

Addresses

Primary practice location

12850 Muscatel St
Hesperia, CA 92344-5566

Mailing address

12850 Muscatel St
Hesperia, CA 92344-5566
Phone (760) 949-0202

Other identifiers 1

IdentifierTypeStateIssuer
36-75044MedicaidCA

National Provider Directory

National Provider Directory

Locations

12850 Muscatel St
Hesperia, CA 92344
Phone (760) 949-0202

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1502150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1366967689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12850 MUSCATEL ST",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923445566",
            "telephone_number": "760-949-0202",
            "fax_number": "760-949-9257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12850 MUSCATEL ST",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923445566",
            "telephone_number": "760-949-0202",
            "fax_number": "760-949-9257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT LEADERSHIP ACADEMY - HIGH DESERT",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-08",
        "last_updated": "2022-07-21",
        "certification_date": "2021-05-20",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "DESIREE",
        "authorized_official_title_or_position": "DIRECTOR, BUSINESS SERVICES",
        "authorized_official_telephone_number": "760-949-9202",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "251300000X",
            "taxonomy_group": "",
            "desc": "Local Education Agency (LEA)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "36-75044",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36-75044",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hesperia, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.