Provider Demographics
NPI:1992388839
Name:EMPRESS EMYRALDZ LLC
Entity Type:Organization
Organization Name:EMPRESS EMYRALDZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:
Authorized Official - First Name:REATHER
Authorized Official - Middle Name:WENDI
Authorized Official - Last Name:KUJORI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-684-9529
Mailing Address - Street 1:160 WINDOVER RD APT 4
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-6054
Mailing Address - Country:US
Mailing Address - Phone:510-684-9529
Mailing Address - Fax:
Practice Address - Street 1:160 WINDOVER RD APT 4
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-6054
Practice Address - Country:US
Practice Address - Phone:510-684-9529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health