Provider Demographics
NPI:1063194140
Name:EMPOWER LIVING SERVICES LLC
Entity type:Organization
Organization Name:EMPOWER LIVING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ADAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:612-756-9140
Mailing Address - Street 1:1701 AMERICAN BLVD E STE 16
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1701 AMERICAN BLVD E STE 16
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1401
Practice Address - Country:US
Practice Address - Phone:612-756-9140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty