Provider Demographics
NPI:1043799083
Name:EMPOWERME REHABILITATION IL AGENCY, LLC
Entity Type:Organization
Organization Name:EMPOWERME REHABILITATION IL AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-485-7979
Mailing Address - Street 1:120 S CENTRAL AVE STE 1050
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1731
Mailing Address - Country:US
Mailing Address - Phone:314-485-7979
Mailing Address - Fax:
Practice Address - Street 1:2225 W MORTON AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-2626
Practice Address - Country:US
Practice Address - Phone:217-245-2996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty