Provider Demographics
NPI:1740770528
Name:EMPOWERING SUPPORTIVE CARE INC
Entity Type:Organization
Organization Name:EMPOWERING SUPPORTIVE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMRORN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-203-3896
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34954-0427
Mailing Address - Country:US
Mailing Address - Phone:772-203-3896
Mailing Address - Fax:
Practice Address - Street 1:2620 S 29TH ST APT B
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34981-5592
Practice Address - Country:US
Practice Address - Phone:772-203-3896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities