Provider Demographics
NPI:1922754639
Name:PRODUCE OPPORTUNITIES WHICH EMBRACE REHABILITATION POWER LLC
Entity Type:Organization
Organization Name:PRODUCE OPPORTUNITIES WHICH EMBRACE REHABILITATION POWER LLC
Other - Org Name:POWER LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NOELLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-240-4174
Mailing Address - Street 1:4316 SEIDEL AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-6429
Mailing Address - Country:US
Mailing Address - Phone:410-240-4174
Mailing Address - Fax:
Practice Address - Street 1:4316 SEIDEL AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-6429
Practice Address - Country:US
Practice Address - Phone:443-208-2031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health