Provider Demographics
NPI:1396513222
Name:EMPOWER SPECTRUM SOLUTIONS LLC
Entity type:Organization
Organization Name:EMPOWER SPECTRUM SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ABDIRISAQ
Authorized Official - Middle Name:KHALIF
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-790-9816
Mailing Address - Street 1:850 44TH AVE S APT 211
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-6782
Mailing Address - Country:US
Mailing Address - Phone:218-790-9816
Mailing Address - Fax:
Practice Address - Street 1:850 44TH AVE S APT 211
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-6782
Practice Address - Country:US
Practice Address - Phone:218-790-9816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency