Healthcare Provider Details

I. General information

NPI: 1871151951
Provider Name (Legal Business Name): ASCEND HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17400 MAGNOLIA BLVD
ENCINO CA
91316-2578
US

IV. Provider business mailing address

4346 EMPRESS AVE
ENCINO CA
91436-3507
US

V. Phone/Fax

Practice location:
  • Phone: 800-646-1202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH ESSAS
Title or Position: MANAGING MEMBER
Credential:
Phone: 310-435-5509