Healthcare Provider Details

I. General information

NPI: 1720955487
Provider Name (Legal Business Name): EMPOWERED TO ACHIEVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2025
Last Update Date: 10/18/2025
Certification Date: 10/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74924 COUNTRY CLUB DR. STE. 150 #101
PALM DESERT CA
92260
US

IV. Provider business mailing address

74924 COUNTRY CLUB DR STE 150
PALM DESERT CA
92260-1969
US

V. Phone/Fax

Practice location:
  • Phone: 909-255-0264
  • Fax:
Mailing address:
  • Phone: 909-255-0264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: DANITRA NICOLE JACKSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 909-255-0264