Provider Demographics
NPI:1326516709
Name:EMPOWERED COMMUNITY LIVING LLC
Entity Type:Organization
Organization Name:EMPOWERED COMMUNITY LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMIKA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-616-6181
Mailing Address - Street 1:1501 ROBERT J CONLAN BLVD NE STE 110
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3560
Mailing Address - Country:US
Mailing Address - Phone:321-499-3265
Mailing Address - Fax:
Practice Address - Street 1:1501 ROBERT J CONLAN BLVD NE STE 110
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3560
Practice Address - Country:US
Practice Address - Phone:321-499-3265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities