Provider Demographics
NPI:1306478854
Name:180 DEGREES EMPOWERMENT CENTER
Entity type:Organization
Organization Name:180 DEGREES EMPOWERMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:MSHS
Authorized Official - Phone:877-829-5500
Mailing Address - Street 1:751 HIGH ST STE C
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15417-2164
Mailing Address - Country:US
Mailing Address - Phone:724-208-9963
Mailing Address - Fax:
Practice Address - Street 1:751 HIGH ST STE C
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15417-2164
Practice Address - Country:US
Practice Address - Phone:724-208-9963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)