Provider Demographics
NPI:1003314675
Name:EMPOWERMENT HEALTHCARE SYSTEMS,LLC
Entity Type:Organization
Organization Name:EMPOWERMENT HEALTHCARE SYSTEMS,LLC
Other - Org Name:EHS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRINCIPAL ASSOCIATE/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AYICHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-698-8284
Mailing Address - Street 1:PO BOX 18844
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-0844
Mailing Address - Country:US
Mailing Address - Phone:410-698-8284
Mailing Address - Fax:
Practice Address - Street 1:9106 PHILADELPHIA RD STE 108B
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4333
Practice Address - Country:US
Practice Address - Phone:410-698-8284
Practice Address - Fax:410-321-1962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD528016800Medicaid