Healthcare Provider Details

I. General information

NPI: 1457107047
Provider Name (Legal Business Name): ASCEND RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E PORTLAND ST
PHOENIX AZ
85006-3154
US

IV. Provider business mailing address

3104 E CAMELBACK RD # 2717
PHOENIX AZ
85016-4502
US

V. Phone/Fax

Practice location:
  • Phone: 623-882-4513
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. SEKOU JACKSON
Title or Position: ADMINISTRATOR
Credential: MPA
Phone: 623-293-7792