Provider Demographics
NPI:1699046839
Name:THE EMPOWERMENT RESURRECTION CENTER
Entity type:Organization
Organization Name:THE EMPOWERMENT RESURRECTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-250-5341
Mailing Address - Street 1:413 AVENUE OF THE STATES
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-4403
Mailing Address - Country:US
Mailing Address - Phone:610-499-7533
Mailing Address - Fax:610-490-7949
Practice Address - Street 1:413 AVENUE OF THE STATES
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-4403
Practice Address - Country:US
Practice Address - Phone:610-499-7533
Practice Address - Fax:610-490-7949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA237090251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health