Provider Demographics
NPI:1083368682
Name:WORTHY WELL EMPOWERED LLC
Entity Type:Organization
Organization Name:WORTHY WELL EMPOWERED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:VINING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-759-8118
Mailing Address - Street 1:1620 E DANA DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2024
Mailing Address - Country:US
Mailing Address - Phone:605-759-8118
Mailing Address - Fax:
Practice Address - Street 1:4301 W 57TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2255
Practice Address - Country:US
Practice Address - Phone:605-335-1516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)