Provider Demographics
NPI:1932548823
Name:ASCENT INDIVIDUAL RESIDENTIAL TREATMENT, INC
Entity Type:Organization
Organization Name:ASCENT INDIVIDUAL RESIDENTIAL TREATMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLENNA
Authorized Official - Middle Name:MASHELL
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-491-3065
Mailing Address - Street 1:330 E 400 S
Mailing Address - Street 2:#2
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-2052
Mailing Address - Country:US
Mailing Address - Phone:801-491-3065
Mailing Address - Fax:801-491-8604
Practice Address - Street 1:330 E 400 S
Practice Address - Street 2:#2
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-2052
Practice Address - Country:US
Practice Address - Phone:801-491-3065
Practice Address - Fax:801-491-8604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT20873253J00000X
UT20874253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency