Healthcare Provider Details

I. General information

NPI: 1649019837
Provider Name (Legal Business Name): EMPOWERED LIVING SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 RUTH AVE
IDAHO FALLS ID
83401-3133
US

IV. Provider business mailing address

580 RUTH AVE
IDAHO FALLS ID
83401-3133
US

V. Phone/Fax

Practice location:
  • Phone: 971-218-4713
  • Fax:
Mailing address:
  • Phone: 406-315-3167
  • Fax: 406-315-3164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: GWENDOLYN D BABINEAU
Title or Position: OFFICE MANAGER
Credential:
Phone: 406-315-3167