Provider Demographics
NPI:1255485827
Name:ASCENT AQUISITION CORP- PSC
Entity Type:Organization
Organization Name:ASCENT AQUISITION CORP- PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COTA
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-245-2210
Mailing Address - Street 1:399 WYLDEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GURDON
Mailing Address - State:AR
Mailing Address - Zip Code:71743-9089
Mailing Address - Country:US
Mailing Address - Phone:870-353-6778
Mailing Address - Fax:
Practice Address - Street 1:2410 PINE ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-4335
Practice Address - Country:US
Practice Address - Phone:870-245-2210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTA-334224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR138586721Medicaid