Provider Demographics
NPI:1124750021
Name:ASCENSION THERAPY SERVICES LLC
Entity type:Organization
Organization Name:ASCENSION THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOACHIM
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-603-2031
Mailing Address - Street 1:702 W GALENA BLVD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-3852
Mailing Address - Country:US
Mailing Address - Phone:815-603-2031
Mailing Address - Fax:
Practice Address - Street 1:1300 N HIGHLAND AVE STE 5
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1464
Practice Address - Country:US
Practice Address - Phone:630-614-1821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health