Provider Demographics
NPI:1376317792
Name:EMPOWERMENT BEHAVIORAL THERAPEUTIC SERVICES LLC
Entity Type:Organization
Organization Name:EMPOWERMENT BEHAVIORAL THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:SHRANK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWC
Authorized Official - Phone:240-565-2558
Mailing Address - Street 1:6475 NEW HAMPSHIRE AVE STE C700
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3269
Mailing Address - Country:US
Mailing Address - Phone:215-801-7893
Mailing Address - Fax:
Practice Address - Street 1:6475 NEW HAMPSHIRE AVE STE C700
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3269
Practice Address - Country:US
Practice Address - Phone:215-801-7893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility