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NPI Code Detail

MEDICARE: EMPIRE GROUP HOMES LLC

MEDICARE: EMPIRE GROUP HOMES 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
1101Y00000XCounselor
2101YM0800XMental Health Counselor
3103TP2701XGroup Psychotherapy Psychologist
41041C0700XClinical Social Worker
5106H00000XMarriage & Family Therapist
6133N00000XNutritionist
7133V00000XRegistered Dietitian
8163W00000XRegistered Nurse
9163WC0400XCase Management Registered Nurse
10163WP0808XPsychiatric/Mental Health Registered Nurse
11164W00000XLicensed Practical Nurse
12322D00000XEmotionally Disturbed Childrens' Residential Treatment Facility
13374U00000XHome Health Aide
14385HR2055XChild Mental Illness Respite Care
15320800000XMental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1275158719
Entity Type Code : Organization
Provider Name (Legal Business Name) : EMPIRE GROUP HOMES LLC
Provider Business Mailing Address
First Line : 1629 W LACEWOOD PL
Second Line :
City : PHOENIX
State : AZ
Zip : 85045-0814
Country : US
Telephone Number : 602-430-3705
Fax Number :
Provider Business Practice Location Address
First Line : 1629 W LACEWOOD PL
Second Line :
City : PHOENIX
State : AZ
Zip : 85045-0814
Country : US
Telephone Number : 602-430-3705
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MS. AMBER R. NASSER
Credential :
Telephone Number : 602-430-3705
Provider Enumeration Date : 06/10/2020
Last Update Date : 06/10/2020

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