Provider Demographics
NPI:1194054437
Name:ASCENSION GROUP LLC
Entity type:Organization
Organization Name:ASCENSION GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-844-9238
Mailing Address - Street 1:828 CAMERON VILLAGE DR
Mailing Address - Street 2:207
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-0913
Mailing Address - Country:US
Mailing Address - Phone:704-844-9238
Mailing Address - Fax:704-844-9238
Practice Address - Street 1:828 CAMERON VILLAGE DR
Practice Address - Street 2:207
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-0913
Practice Address - Country:US
Practice Address - Phone:704-844-9238
Practice Address - Fax:704-844-9238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health