Provider Demographics
NPI:1679246466
Name:HOME OF PURPOSE EMPOWERMENT
Entity Type:Organization
Organization Name:HOME OF PURPOSE EMPOWERMENT
Other - Org Name:HOPE AZ III
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ELONDA
Authorized Official - Middle Name:W
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-690-5309
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:860-690-5309
Mailing Address - Fax:
Practice Address - Street 1:30041 W EARLL DR
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396-3178
Practice Address - Country:US
Practice Address - Phone:623-444-2267
Practice Address - Fax:623-248-8266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness