Provider Demographics
NPI:1235504184
Name:ASCENDIGO AUTISM SERVICES, INC.
Entity Type:Organization
Organization Name:ASCENDIGO AUTISM SERVICES, INC.
Other - Org Name:EXTREME SPORTS CAMP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-927-3143
Mailing Address - Street 1:PO BOX 10725
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81612-9780
Mailing Address - Country:US
Mailing Address - Phone:970-340-4922
Mailing Address - Fax:
Practice Address - Street 1:818 INDUSTRY WAY
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-2508
Practice Address - Country:US
Practice Address - Phone:970-340-4922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10X839251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO81933771Medicaid