Healthcare Provider Details

I. General information

NPI: 1588122485
Provider Name (Legal Business Name): ASCEND BEHAVIOR CENTER CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2019
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10659 95TH ST
OZONE PARK NY
11417-1541
US

IV. Provider business mailing address

10659 95TH ST
OZONE PARK NY
11417-1541
US

V. Phone/Fax

Practice location:
  • Phone: 347-552-4549
  • Fax:
Mailing address:
  • Phone: 347-552-4549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: CHERRY ANN MONTEHERMOSO CHISHTI
Title or Position: PROGRAM DIRECTOR
Credential: M.ED
Phone: 134-755-2549