Provider Demographics
NPI:1558901355
Name:DESTINY EMPOWERMENT HOUSE AND GROUPS LLC
Entity Type:Organization
Organization Name:DESTINY EMPOWERMENT HOUSE AND GROUPS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANAMEGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-269-2423
Mailing Address - Street 1:18 N 7TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2110
Mailing Address - Country:US
Mailing Address - Phone:570-269-2423
Mailing Address - Fax:888-270-4116
Practice Address - Street 1:18 N 7TH ST FL 2
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2110
Practice Address - Country:US
Practice Address - Phone:570-269-2423
Practice Address - Fax:888-270-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health