Provider Demographics
NPI:1659065530
Name:AMAYLA EMPOWERMENT ASSOCIATION, LLC
Entity Type:Organization
Organization Name:AMAYLA EMPOWERMENT ASSOCIATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FALKERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-377-3864
Mailing Address - Street 1:435 JULIE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-2924
Mailing Address - Country:US
Mailing Address - Phone:608-377-3864
Mailing Address - Fax:
Practice Address - Street 1:435 JULIE ST STE 2
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-2924
Practice Address - Country:US
Practice Address - Phone:608-377-3864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty