Provider Demographics
NPI:1740774033
Name:ASCEND HEALTH ADULT RETREAT, LLC
Entity Type:Organization
Organization Name:ASCEND HEALTH ADULT RETREAT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-641-0952
Mailing Address - Street 1:6421 CHESTERFIELD MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-8810
Mailing Address - Country:US
Mailing Address - Phone:804-621-4209
Mailing Address - Fax:800-425-4412
Practice Address - Street 1:6421 CHESTERFIELD MEADOWS DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-8810
Practice Address - Country:US
Practice Address - Phone:804-621-4209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251S00000XAgenciesCommunity/Behavioral Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)