MEDICARE: ASCEND RECOVERY SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	324500000X	Substance Abuse Rehabilitation Facility
2	251S00000X	Community/Behavioral Health Agency
3	323P00000X	Psychiatric Residential Treatment Facility
4	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1457107047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCEND RECOVERY SERVICES

Provider Business Mailing Address
First Line	:	3104 E CAMELBACK RD # 2717
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 E PORTLAND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-3154
Country	:	US
Telephone Number	:	623-882-4513
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. SEKOU JACKSON
Credential	:	MPA
Telephone Number	:	623-293-7792

Provider Enumeration Date	:	04/25/2024
Last Update Date	:	04/25/2024

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Directions to “ASCEND RECOVERY SERVICES ” Practice Location

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