MEDICARE: THE EMPOWER COLLECTIVE LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1003770660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EMPOWER COLLECTIVE LLC.

Provider Business Mailing Address
First Line	:	9805 CAMPO RD STE 165
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977-1471
Country	:	US
Telephone Number	:	619-889-8728
Fax Number	:

Provider Business Practice Location Address
First Line	:	9805 CAMPO RD STE 165
Second Line	:	P.O BOX 65
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977-1471
Country	:	US
Telephone Number	:	619-889-8728
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ISABELLA F CAVELLA
Credential	:
Telephone Number	:	619-889-8728

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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