Healthcare Provider Details

I. General information

NPI: 1063025195
Provider Name (Legal Business Name): ASCEND ABA COLORADO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 FREQUENT FLYER PT
COLORADO SPRINGS CO
80915-1500
US

IV. Provider business mailing address

5545 WILSON RD
COLORADO SPRINGS CO
80919-3530
US

V. Phone/Fax

Practice location:
  • Phone: 800-345-0448
  • Fax:
Mailing address:
  • Phone: 913-706-5149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY R CHAMPLIN
Title or Position: OWNER
Credential:
Phone: 913-706-5149