Organization
ASCENDING ROOTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STEPHANIE JOHNSON (PRESIDENT)
(480) 779-8016
Entity
Organization
Contact information
Practice address
1839 N 39TH ST, PHOENIX, AZ 85008-3915
(480) 797-9438
Mailing address
2303 N 44TH ST, 14-1198, PHOENIX, AZ 85008-2442
(480) 779-8016
(602) 341-6962
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
BH4858
AZ
323P00000X
Psychiatric Residential Treatment Facility
Primary
BH4858
AZ
Other
Enumeration date
06/01/2016
Last updated
06/01/2016
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