Provider Demographics
NPI:1568158152
Name:EMPOWER RESIDENTIAL WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:EMPOWER RESIDENTIAL WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-803-8816
Mailing Address - Street 1:559 CHAPARRAL CT
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-3859
Mailing Address - Country:US
Mailing Address - Phone:618-803-8816
Mailing Address - Fax:
Practice Address - Street 1:22119 BASSETT ST
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-2305
Practice Address - Country:US
Practice Address - Phone:618-803-8816
Practice Address - Fax:949-281-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility