Provider Demographics
NPI:1689366072
Name:EMPRESS EMPIRE
Entity Type:Organization
Organization Name:EMPRESS EMPIRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:SHERRELL
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:HOME HEALTH ADENCY
Authorized Official - Phone:586-280-7436
Mailing Address - Street 1:21117 DEXTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-3405
Mailing Address - Country:US
Mailing Address - Phone:158-628-0743
Mailing Address - Fax:
Practice Address - Street 1:21117 DEXTER BLVD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-3405
Practice Address - Country:US
Practice Address - Phone:158-628-0743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health