Provider Demographics
NPI:1679228688
Name:HOME OF PURPOSE EMPOWERMENT LLC
Entity Type:Organization
Organization Name:HOME OF PURPOSE EMPOWERMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
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:
Authorized Official - Phone:602-935-1611
Mailing Address - Street 1:PO BOX 5135
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85376-5135
Mailing Address - Country:US
Mailing Address - Phone:602-935-1611
Mailing Address - Fax:623-248-8266
Practice Address - Street 1:5224 S 22ND WAY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-3401
Practice Address - Country:US
Practice Address - Phone:602-935-1611
Practice Address - Fax:623-248-8266
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOME OF PURPOSE EMPOWERMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility