Provider Demographics
NPI:1578256319
Name:EMPOWERING EXCEPTIONAL INDIVIDUALS LLC
Entity Type:Organization
Organization Name:EMPOWERING EXCEPTIONAL INDIVIDUALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:TASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-838-3595
Mailing Address - Street 1:7915 MOUNT CLARE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLARE
Mailing Address - State:WV
Mailing Address - Zip Code:26408-9535
Mailing Address - Country:US
Mailing Address - Phone:304-838-3595
Mailing Address - Fax:
Practice Address - Street 1:7915 MOUNT CLARE RD
Practice Address - Street 2:
Practice Address - City:MOUNT CLARE
Practice Address - State:WV
Practice Address - Zip Code:26408-9535
Practice Address - Country:US
Practice Address - Phone:304-838-3595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health