MEDICARE: ASCEND BEHAVIORAL HEALTH AND WELLNESS,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1437754850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCEND BEHAVIORAL HEALTH AND WELLNESS,LLC

Provider Business Mailing Address
First Line	:	2413 W FETLOCK TRL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-5770
Country	:	US
Telephone Number	:	160-246-0144
Fax Number	:

Provider Business Practice Location Address
First Line	:	3418 W LITTLE HOPI DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-2272
Country	:	US
Telephone Number	:	602-471-5053
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ROBERTA ABDALLAH
Credential	:
Telephone Number	:	602-460-1449

Provider Enumeration Date	:	12/02/2020
Last Update Date	:	12/17/2020

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