Organization
SUMMERSIDE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD ANDERSON (ADMINISTRATOR)
(707) 552-7241
Entity
Organization
Contact information
Practice address
180 GUAVA CT, VALLEJO, CA 94589-2321
(707) 552-7241
Mailing address
180 GUAVA CT, VALLEJO, CA 94589-2321
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
LTC60118F
CA
Other
Enumeration date
04/18/2008
Last updated
04/18/2008
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