Ascend Wellness, Llc | |
148 Commercial Dr London KY 40744-8204 | |
(606) 260-8532 | |
(606) 260-8534 |
Full Name | Ascend Wellness, Llc |
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Speciality | Counselor |
Location | 148 Commercial Dr, London, Kentucky |
Authorized Official Name and Position | Stephanie Gail Hall (CREDENTIALING AGENT) |
Authorized Official Contact | 5027740671 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Ascend Wellness, Llc 148 Commercial Dr London KY 40744-8204 Ph: (606) 309-2531 | Ascend Wellness, Llc 148 Commercial Dr London KY 40744-8204 Ph: (606) 260-8532 |
NPI Number | 1619725579 |
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Provider Enumeration Date | 05/07/2024 |
Last Update Date | 11/19/2024 |
Certification Date | 11/19/2024 |
Medicare PECOS PAC ID | 1658801501 |
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Medicare Enrollment ID | O20250207002093 |
Identifier | Type | State | Issuer |
---|---|---|---|
1619725579 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
Provider Name | Jessica M Brock |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1295148914 PECOS PAC ID: 2961622600 Enrollment ID: I20141001001762 |
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