Provider Demographics
NPI:1710287933
Name:EMPOWERED FAITH BOARDING HOMES
Entity Type:Organization
Organization Name:EMPOWERED FAITH BOARDING HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:E
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:972-603-8119
Mailing Address - Street 1:PO BOX 5473
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0214
Mailing Address - Country:US
Mailing Address - Phone:972-603-8119
Mailing Address - Fax:
Practice Address - Street 1:3100 DEER RUN DR
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-6626
Practice Address - Country:US
Practice Address - Phone:972-603-8119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health