Provider Demographics
NPI:1174406441
Name:EMPOWER PATH SUPPORT LLC
Entity type:Organization
Organization Name:EMPOWER PATH SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADEBAMBO
Authorized Official - Middle Name:C
Authorized Official - Last Name:OGUNNUPE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:202-486-1744
Mailing Address - Street 1:9324 MULLIGAN WAY
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:MD
Mailing Address - Zip Code:21875-2668
Mailing Address - Country:US
Mailing Address - Phone:202-276-9353
Mailing Address - Fax:
Practice Address - Street 1:107 WALNUT LN
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5001
Practice Address - Country:US
Practice Address - Phone:443-355-7517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-25
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health