Healthcare Provider Details

I. General information

NPI: 1699603266
Provider Name (Legal Business Name): ASCENOVA BIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 RIVERS AVE
NORTH CHARLESTON SC
29406-4809
US

IV. Provider business mailing address

30 N GOULD ST STE N
SHERIDAN WY
82801-6317
US

V. Phone/Fax

Practice location:
  • Phone: 864-412-6557
  • Fax:
Mailing address:
  • Phone: 864-412-6557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL JOEL SIMMONS
Title or Position: FOUNDER
Credential:
Phone: 864-412-6557