Provider Demographics
NPI:1811432313
Name:DESTINY EMPOWERMENT HOUSE AND GROUPS LLC
Entity type:Organization
Organization Name:DESTINY EMPOWERMENT HOUSE AND GROUPS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANAMEGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-269-2423
Mailing Address - Street 1:5013 PINE RIDGE RD S
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18302-8669
Mailing Address - Country:US
Mailing Address - Phone:570-269-2423
Mailing Address - Fax:
Practice Address - Street 1:5013 PINE RIDGE RD S
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18302-8669
Practice Address - Country:US
Practice Address - Phone:570-269-2423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN572318251F00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN572318OtherBUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS