LAURISSA SUMMERLIN (NPI# 1144865627) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144865627 |
| Entity Type | Individual |
| Full Name | LAURISSA SUMMERLIN |
| Credential | CDCA |
| Practice Address |
4930 Enterprise Dr Nw Warren OH 44481-8706 |
| Practice Telephone | 3307870955 |
| Mailing Telephone | 3307870955 |
| Enumeration Date | 2019-11-08 |
| Last Update Date | 2019-11-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 171941 | OH | Residential Treatment Facilities |
| Street Address |
4930 ENTERPRISE DR NW |
| City | WARREN |
| State | OH |
| Zip Code | 44481-8706 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598766859 | Joseph Lydon Jr. | Anesthesiology | 4930 Enterprise Dr Nw, Warren, OH 44481-8706 | 2005-08-09 |
| 1932707304 | Wendy Tyler | Licensed Practical Nurse | 4930 Enterprise Dr Nw, Warren, OH 44481-8706 | 2020-10-16 |
| 1235740507 | Amanda Kehres | Licensed Practical Nurse | 4930 Enterprise Dr Nw, Warren, OH 44481-8706 | 2020-08-11 |
| 1013533173 | Diane Smolak | Substance Abuse Rehabilitation Facility | 4930 Enterprise Dr Nw, Warren, OH 44481-8706 | 2020-06-24 |
| 1780206540 | Andrea Christine Matzye | Counselor | 4930 Enterprise Dr Nw, Warren, OH 44481-8706 | 2020-05-14 |
| 1174159990 | Gregory Solomon | Social Worker | 4930 Enterprise Dr Nw, Warren, OH 44481-8706 | 2020-03-13 |
| 1215562186 | James Meyer | Substance Abuse Rehabilitation Facility | 4930 Enterprise Dr Nw, Warren, OH 44481-8706 | 2020-03-11 |
| 1144852864 | Gaye Tyhosky | Registered Nurse | 4930 Enterprise Dr Nw, Warren, OH 44481-8706 | 2020-02-11 |
| 1124667514 | Dalton Kinder | Substance Abuse Rehabilitation Facility | 4930 Enterprise Dr Nw, Warren, OH 44481-8706 | 2020-01-02 |
| 1477197515 | Jennifer Perkinson | Substance Abuse Rehabilitation Facility | 4930 Enterprise Dr Nw, Warren, OH 44481-8706 | 2019-11-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215447321 | Fresenius Medical Care Youngstown, LLC | Clinic/Center | 4941 Enterprise Blvd Nw, Warren, OH 44481 | 2017-10-03 |
| 1942728407 | Amy Senne | Case Manager/Care Coordinator | 840 Hallock Young Rd Sw, Warren, OH 44481 | 2017-09-05 |
| 1669858486 | Team Sanders Inc | Respite Care | 893 Tait Rd, Warren, OH 44481 | 2015-08-04 |
| 1821492810 | Deirdre Bielecki | Dental Hygienist | 418 Main Avenue Sw, Warren, OH 44481 | 2014-10-20 |
| 1942413497 | Scope Inc | Home Health | 220 West Market Street, Warren, OH 44481 | 2007-05-08 |
| 1972624377 | Warren City Auditor | Public Health or Welfare | 258 E Market St, Warren, OH 44481 | 2007-04-03 |
| 1780703025 | Cythnia Coleman | Social Worker | 150 E. Market Street- Primary Practice Address, Warren, OH 44481 | 2007-03-28 |
| 1780036079 | Carol Henderson | Counselor | 320 High St Ne, Warren, OH 44481 | 2016-07-11 |
| 1801112081 | Michael F Potesta | Psychiatry & Neurology | 150 E Market St, Warren, OH 44481 | 2010-04-13 |
| 1568592624 | June Marie Mollic | Counselor | 150 E Market St, Warren, OH 44481 | 2007-03-07 |
| Find all providers in zip 44481 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790216448 | Jeannie Gurich | Substance Abuse Rehabilitation Facility | 2737 Youngstown Warren Rd. Se, Warren, OH 44483 | 2017-03-24 |
| 1598206898 | Stan Catullo | Substance Abuse Rehabilitation Facility | 2737 Youngstown Warren Road Se, Warren, OH 44484 | 2017-03-20 |
| 1376805515 | 10th District Substance Abuse Treatment Center | Substance Abuse Rehabilitation Facility | 412 York St, Warren, AR 71671-3218 | 2012-06-13 |
| 1750998035 | Robert Bennett | Substance Abuse Rehabilitation Facility | 2737 Youngstown Rd Se, Warren, OH 44484-5002 | 2020-09-30 |
| 1073120671 | Sheena Ahmed | Substance Abuse Rehabilitation Facility | 2737 Youngstown Rd Se, Warren, OH 44484-5002 | 2020-09-28 |
| 1073124368 | Justin Wilcox | Substance Abuse Rehabilitation Facility | 2737 Youngstown Rd Se, Warren, OH 44484-5002 | 2020-08-11 |
| 1497372809 | Justin Dietrich | Substance Abuse Rehabilitation Facility | 2737 Youngstown Rd Se, Warren, OH 44484-5002 | 2020-07-01 |
| 1447877147 | Open Water Counseling and Recovery, LLC | Substance Abuse Rehabilitation Facility | 1725 Drexel Ave Nw, Warren, OH 44485-2121 | 2020-06-29 |
| 1013533173 | Diane Smolak | Substance Abuse Rehabilitation Facility | 4930 Enterprise Dr Nw, Warren, OH 44481-8706 | 2020-06-24 |
| 1487270872 | Amber Peterson | Substance Abuse Rehabilitation Facility | 2737 Youngstown Rd Se, Warren, OH 44484-5002 | 2020-06-22 |
| Find all providers in WARREN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.