Healthcare Provider Details

I. General information

NPI: 1053022160
Provider Name (Legal Business Name): ASCEND HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 VIVIANA DR
TARZANA CA
91356-5038
US

IV. Provider business mailing address

4346 EMPRESS AVE
ENCINO CA
91436-3507
US

V. Phone/Fax

Practice location:
  • Phone: 310-435-5509
  • Fax:
Mailing address:
  • Phone: 310-435-5509
  • 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 DIRECTOR
Credential:
Phone: 310-435-5509