Healthcare Provider Details

I. General information

NPI: 1053222828
Provider Name (Legal Business Name): ASCEND COMMUNITY SUPPORT NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11255 CREEK HAVEN DR
RIVERVIEW FL
33569-6209
US

IV. Provider business mailing address

11255 CREEK HAVEN DR
RIVERVIEW FL
33569-6209
US

V. Phone/Fax

Practice location:
  • Phone: 240-703-6320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: LYISSA CHATMON
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 240-703-6320