Provider Demographics
NPI:1265891477
Name:ASCEND CLINICAL SERVICES
Entity type:Organization
Organization Name:ASCEND CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP OF BUSINESS DEVELOPMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-708-1468
Mailing Address - Street 1:33 TEEN CHALLENGE RD
Mailing Address - Street 2:PO BOX 98
Mailing Address - City:REHRERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19550-5000
Mailing Address - Country:US
Mailing Address - Phone:717-933-4181
Mailing Address - Fax:717-754-0617
Practice Address - Street 1:33 TEEN CHALLENGE RD
Practice Address - Street 2:
Practice Address - City:REHRERSBURG
Practice Address - State:PA
Practice Address - Zip Code:19550-5000
Practice Address - Country:US
Practice Address - Phone:717-933-4181
Practice Address - Fax:717-754-0617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X, 251S00000X
PA062579324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251K00000XAgenciesPublic Health or Welfare
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103149980-0006Medicaid
PA103149980-0001Medicaid
PA103149980-0005Medicaid