Provider Demographics
NPI:1851025258
Name:EMPOWER SHECOLBY'S MOVEMENT LLC,
Entity Type:Organization
Organization Name:EMPOWER SHECOLBY'S MOVEMENT LLC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHECOLBY
Authorized Official - Middle Name:LEMAY
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:313-492-2781
Mailing Address - Street 1:5517 JOHN C LODGE FWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3346
Mailing Address - Country:US
Mailing Address - Phone:313-492-2781
Mailing Address - Fax:
Practice Address - Street 1:5517 JOHN C LODGE FWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3346
Practice Address - Country:US
Practice Address - Phone:313-492-2781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health