Provider Demographics
NPI:1770134488
Name:EMPIRE HEALTH GROUP LLC
Entity type:Organization
Organization Name:EMPIRE HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ASERE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MWARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-685-1147
Mailing Address - Street 1:4518 E COYOTE WASH DR
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-4026
Mailing Address - Country:US
Mailing Address - Phone:480-685-1147
Mailing Address - Fax:
Practice Address - Street 1:35612 N 34TH LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85086-2263
Practice Address - Country:US
Practice Address - Phone:480-685-1147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder