Provider Demographics
NPI:1619302494
Name:ASCEND CHC, LCC
Entity Type:Organization
Organization Name:ASCEND CHC, LCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CONVISER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-283-2650
Mailing Address - Street 1:737 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1625
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2615
Mailing Address - Country:US
Mailing Address - Phone:312-283-2650
Mailing Address - Fax:312-888-9937
Practice Address - Street 1:700 S GREGORY ST
Practice Address - Street 2:SUITE A
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-3745
Practice Address - Country:US
Practice Address - Phone:217-531-4796
Practice Address - Fax:217-607-5432
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASCEND CHC, LCC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004906133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty