Provider Demographics
NPI:1750944609
Name:EMPOWERED LIVING SERVICES
Entity type:Organization
Organization Name:EMPOWERED LIVING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:LESURE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:248-850-6235
Mailing Address - Street 1:18100 MEYERS RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1493
Mailing Address - Country:US
Mailing Address - Phone:248-850-6235
Mailing Address - Fax:
Practice Address - Street 1:18100 MEYERS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1493
Practice Address - Country:US
Practice Address - Phone:248-850-6235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000000000OtherN/A