Provider Demographics
NPI:1427223288
Name:COMMUNITY EMPOWERMENT PROGRAM, LLC
Entity Type:Organization
Organization Name:COMMUNITY EMPOWERMENT PROGRAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CLINTRAL
Authorized Official - Middle Name:TRIMELLE
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-266-3909
Mailing Address - Street 1:PO BOX 1186
Mailing Address - Street 2:9545 KENNEDY STATION TERRACE
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-1186
Mailing Address - Country:US
Mailing Address - Phone:809-426-6390
Mailing Address - Fax:804-266-3930
Practice Address - Street 1:9545 KENNEDY STATION TER
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3933
Practice Address - Country:US
Practice Address - Phone:809-426-6390
Practice Address - Fax:804-266-3930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VASS-230-07253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010177162OtherDEPARTMENT OF MEDICAL ASSISTANCE SERVICES