Provider Demographics
NPI:1053864850
Name:EMPOWERING INTEGRATED CARE SOLUTIONS, LLC
Entity Type:Organization
Organization Name:EMPOWERING INTEGRATED CARE SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-532-3427
Mailing Address - Street 1:23215 COMMERCE PARK
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5803
Mailing Address - Country:US
Mailing Address - Phone:216-532-3427
Mailing Address - Fax:
Practice Address - Street 1:23215 COMMERCE PARK
Practice Address - Street 2:SUITE 306
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5803
Practice Address - Country:US
Practice Address - Phone:216-532-3427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0189274Medicaid