Provider Demographics
NPI:1770306219
Name:EMPOWERHEALTH REFERRALS & TRAINING
Entity type:Organization
Organization Name:EMPOWERHEALTH REFERRALS & TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY HEALTH WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:CHW
Authorized Official - Phone:888-305-8355
Mailing Address - Street 1:809 CENTER ST STE 7B
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-5257
Mailing Address - Country:US
Mailing Address - Phone:888-305-8355
Mailing Address - Fax:517-485-7581
Practice Address - Street 1:455 E EISENHOWER PKWY STE 300
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3324
Practice Address - Country:US
Practice Address - Phone:888-305-8355
Practice Address - Fax:517-485-7581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1336918309Medicaid