Healthcare Provider Details

I. General information

NPI: 1780405043
Provider Name (Legal Business Name): EMPOWERMENT ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 N 19TH AVE STE 430
PHOENIX AZ
85015-2481
US

IV. Provider business mailing address

5501 N 19TH AVE STE 430
PHOENIX AZ
85015-2481
US

V. Phone/Fax

Practice location:
  • Phone: 602-524-5521
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: JIMMY EVANS
Title or Position: MANAGER
Credential:
Phone: 602-524-5521