Provider Demographics
NPI:1710348362
Name:THE EMPOWER HOUSE, LLC
Entity Type:Organization
Organization Name:THE EMPOWER HOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:623-986-3987
Mailing Address - Street 1:18631 N. 19TH AVE., SUITE 158-305
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027
Mailing Address - Country:US
Mailing Address - Phone:623-986-3987
Mailing Address - Fax:
Practice Address - Street 1:18631 N. 19TH AVE., SUITE 158-305
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027
Practice Address - Country:US
Practice Address - Phone:623-986-3987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VOICES EMPOWERED, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-10
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4796320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness