MEDICARE: ASCENDING ROOTS

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	BH4858	AZ
2	323P00000X	Psychiatric Residential Treatment Facility	BH4858	AZ

General Provider Information

NPI Number	:	1760830533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCENDING ROOTS

Provider Business Mailing Address
First Line	:	2303 N 44TH ST
Second Line	:	14-1198
City	:	PHOENIX
State	:	AZ
Zip	:	85008-2442
Country	:	US
Telephone Number	:	480-779-8016
Fax Number	:	602-341-6962

Provider Business Practice Location Address
First Line	:	1839 N 39TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-3915
Country	:	US
Telephone Number	:	480-797-9438
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. STEPHANIE JOHNSON
Credential	:
Telephone Number	:	480-779-8016

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	06/01/2016

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Directions to “ASCENDING ROOTS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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