Healthcare Provider Details

I. General information

NPI: 1740774033
Provider Name (Legal Business Name): ASCEND HEALTH ADULT RETREAT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6421 CHESTERFIELD MEADOWS DR
CHESTERFIELD VA
23832-8810
US

IV. Provider business mailing address

PO BOX 4101
MIDLOTHIAN VA
23112-0002
US

V. Phone/Fax

Practice location:
  • Phone: 804-621-4209
  • Fax:
Mailing address:
  • Phone: 804-621-4209
  • Fax: 800-425-4412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: PHONYA LEWIS
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 804-641-0952