Provider Demographics
NPI:1609446418
Name:HOME OF PURPOSE EMPOWERMENT
Entity Type:Organization
Organization Name:HOME OF PURPOSE EMPOWERMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELONDA
Authorized Official - Middle Name:W
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-690-5309
Mailing Address - Street 1:11853 W NADINE WAY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-4522
Mailing Address - Country:US
Mailing Address - Phone:860-690-5309
Mailing Address - Fax:
Practice Address - Street 1:19752 W BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-3054
Practice Address - Country:US
Practice Address - Phone:623-248-8269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness