Provider Demographics
NPI:1750859583
Name:ASCENT HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:ASCENT HEALTH SERVICES LLC
Other - Org Name:BRIDGE DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TANGINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-636-5055
Mailing Address - Street 1:29222 RANCHO VIEJO RD STE 127
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1049
Mailing Address - Country:US
Mailing Address - Phone:949-426-3767
Mailing Address - Fax:949-540-1966
Practice Address - Street 1:1213 FLINT MEADOW DR STE 1C
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-6833
Practice Address - Country:US
Practice Address - Phone:385-420-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment