Provider Demographics
NPI:1326472135
Name:IMPOWER
Entity Type:Organization
Organization Name:IMPOWER
Other - Org Name:IMPOWER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TARGETED CASE MNANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-556-6076
Mailing Address - Street 1:222 BROADWAY
Mailing Address - Street 2:211
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5781
Mailing Address - Country:US
Mailing Address - Phone:407-931-2911
Mailing Address - Fax:
Practice Address - Street 1:222 BROADWAY
Practice Address - Street 2:211
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5781
Practice Address - Country:US
Practice Address - Phone:407-931-2911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health