Provider Demographics
NPI:1104631191
Name:2 EMPOWER
Entity type:Organization
Organization Name:2 EMPOWER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JERESIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:TRIPLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:662-803-9168
Mailing Address - Street 1:272 CALHOUN STATION PKWY STE 2179
Mailing Address - Street 2:
Mailing Address - City:GLUCKSTADT
Mailing Address - State:MS
Mailing Address - Zip Code:39110-5540
Mailing Address - Country:US
Mailing Address - Phone:662-803-9168
Mailing Address - Fax:
Practice Address - Street 1:272 CALHOUN STATION PKWY STE 2179
Practice Address - Street 2:
Practice Address - City:GLUCKSTADT
Practice Address - State:MS
Practice Address - Zip Code:39110-5540
Practice Address - Country:US
Practice Address - Phone:662-803-9168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-08
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based