Provider Demographics
NPI:1770029696
Name:EMPOWERED LIVING HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:EMPOWERED LIVING HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LACRETIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANCONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-410-5008
Mailing Address - Street 1:158 LITTLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-1524
Mailing Address - Country:US
Mailing Address - Phone:513-410-5008
Mailing Address - Fax:
Practice Address - Street 1:158 LITTLEBROOK DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-1524
Practice Address - Country:US
Practice Address - Phone:513-410-5008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No302R00000XManaged Care OrganizationsHealth Maintenance Organization