Summerside Inc

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

LTC60118F Issued in CA

Legal business name

SUMMERSIDE INC

Practice address

180 Guava CT
Vallejo, CA 94589-2321

Phone

(707) 552-7241

NPI assigned

Apr 18, 2008

Last updated

Apr 18, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Edward Anderson

Title

Administrator

Phone

(707) 552-7241

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1208476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208476800000",
    "number": "1700050895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 GUAVA CT",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945892321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 GUAVA CT",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945892321",
            "telephone_number": "707-552-7241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERSIDE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-18",
        "last_updated": "2008-04-18",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "707-552-7241"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CA",
            "license": "LTC60118F",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thyreak Suggs
• Sheerin Sulaiman
• Jaime Lee Summerall-Alton, MSW
• Amanda May Kleeman Summers, LPC-S, LPCC, NCC, MS
• Jeramy Bernard Summers, LPT
• Hannah Raychee Sun
• Jiaming Sun
• Kathleen Shehua Sun
• Daniel Sunboliyan, DPM
• Sima Sura, M.D.

• Mental Health Clinic/Center (Including Community Mental Health Center) in Vallejo, CA
• Providers in Vallejo, CA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2008; 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.