Provider Demographics
NPI:1609389725
Name:EMERGE EMPOWERMENT MOVEMENT
Entity Type:Organization
Organization Name:EMERGE EMPOWERMENT MOVEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LA CHETT
Authorized Official - Middle Name:KATRENIA
Authorized Official - Last Name:LANDRUM
Authorized Official - Suffix:
Authorized Official - Credentials:COSMETOLOGIST
Authorized Official - Phone:202-321-0272
Mailing Address - Street 1:5835 FISHER RD APT 12
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-5916
Mailing Address - Country:US
Mailing Address - Phone:202-321-0272
Mailing Address - Fax:
Practice Address - Street 1:872 LARGO CENTER DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-3705
Practice Address - Country:US
Practice Address - Phone:202-321-0272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD219400335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier