Provider Demographics
NPI:1104910868
Name:IMPOWER, INC.
Entity type:Organization
Organization Name:IMPOWER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KESIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-215-0095
Mailing Address - Street 1:2290 N RONALD REAGAN BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3534
Mailing Address - Country:US
Mailing Address - Phone:407-215-0095
Mailing Address - Fax:407-261-0523
Practice Address - Street 1:2290 N RONALD REAGAN BLVD STE 116
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-3534
Practice Address - Country:US
Practice Address - Phone:407-331-8002
Practice Address - Fax:407-331-8659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No284300000XHospitalsSpecial HospitalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL360212502Medicaid
FL013827000Medicaid
FL006714202Medicaid
FL006714203Medicaid
FL360212500Medicaid
FL360212505Medicaid
FL006714200Medicaid
FL006714201Medicaid
FL759027000Medicaid
FL005979100Medicaid
FL007186500Medicaid