Provider Demographics
NPI:1275210791
Name:POWELL ENTERPRISES LLC
Entity Type:Organization
Organization Name:POWELL ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:SHEA
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-914-2216
Mailing Address - Street 1:4047 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1914
Mailing Address - Country:US
Mailing Address - Phone:262-914-2216
Mailing Address - Fax:
Practice Address - Street 1:4047 32ND AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1914
Practice Address - Country:US
Practice Address - Phone:262-914-2216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROYALE TRANSITIONAL LIVING HOMES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home