Provider Demographics
NPI:1669912580
Name:ASCENSION TREATMENT CENTERS LLC
Entity type:Organization
Organization Name:ASCENSION TREATMENT CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ALPHONSO
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:323-493-6064
Mailing Address - Street 1:4804 PARKGLEN AVE
Mailing Address - Street 2:
Mailing Address - City:VIEW PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1012
Mailing Address - Country:US
Mailing Address - Phone:323-792-4007
Mailing Address - Fax:323-792-4474
Practice Address - Street 1:4804 PARKGLEN AVE
Practice Address - Street 2:
Practice Address - City:VIEW PARK
Practice Address - State:CA
Practice Address - Zip Code:90043-1012
Practice Address - Country:US
Practice Address - Phone:323-792-4007
Practice Address - Fax:323-792-4474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility