Provider Demographics
NPI:1134668775
Name:EMPOWER HEALTHCARE CORP.
Entity Type:Organization
Organization Name:EMPOWER HEALTHCARE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOTENBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-281-5100
Mailing Address - Street 1:105 SE 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1559
Mailing Address - Country:US
Mailing Address - Phone:503-281-5100
Mailing Address - Fax:503-235-0120
Practice Address - Street 1:105 SE 18TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1559
Practice Address - Country:US
Practice Address - Phone:503-281-5100
Practice Address - Fax:503-235-0120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMAART HOLDING CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR107927998261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center