Provider Demographics
NPI:1346809357
Name:EMPOWERED LIVING COMMUNITY CENTER CORP.
Entity Type:Organization
Organization Name:EMPOWERED LIVING COMMUNITY CENTER CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAIKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROQUE RUANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-547-1568
Mailing Address - Street 1:950 SW 57TH AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5087
Mailing Address - Country:US
Mailing Address - Phone:786-547-1568
Mailing Address - Fax:
Practice Address - Street 1:950 SW 57TH AVE APT 704
Practice Address - Street 2:
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5094
Practice Address - Country:US
Practice Address - Phone:786-547-1568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management