Provider Demographics
NPI:1346641727
Name:ASCEND REHAB LLC
Entity type:Organization
Organization Name:ASCEND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-989-6495
Mailing Address - Street 1:PO BOX 515056
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-5056
Mailing Address - Country:US
Mailing Address - Phone:432-617-7463
Mailing Address - Fax:972-960-9997
Practice Address - Street 1:1330 E 8TH ST
Practice Address - Street 2:111
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4702
Practice Address - Country:US
Practice Address - Phone:432-332-4523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC21902Medicare UPIN