Provider Demographics
NPI:1700371002
Name:EMPOWERMENT CENTER OF SOUTHERN NEVADA LLC
Entity type:Organization
Organization Name:EMPOWERMENT CENTER OF SOUTHERN NEVADA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-721-8508
Mailing Address - Street 1:1024 W OWENS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2520
Mailing Address - Country:US
Mailing Address - Phone:702-636-8729
Mailing Address - Fax:702-441-1808
Practice Address - Street 1:1024 W OWENS AVE STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2520
Practice Address - Country:US
Practice Address - Phone:702-636-8729
Practice Address - Fax:702-441-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WP0808X, 171M00000X, 251B00000X, 261QA0600X, 261QM0801X, 261QP2300X, 291U00000X, 343900000X
NVNV20181464682251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No291U00000XLaboratoriesClinical Medical Laboratory
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)