Provider Demographics
NPI:1700613031
Name:EMPOWERED KIDS LLC
Entity type:Organization
Organization Name:EMPOWERED KIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED CHILD LIFE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:MELAND
Authorized Official - Suffix:
Authorized Official - Credentials:CCLS
Authorized Official - Phone:843-743-5509
Mailing Address - Street 1:4637 COLFAX AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-5335
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4637 COLFAX AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-5335
Practice Address - Country:US
Practice Address - Phone:612-204-2003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty