Healthcare Provider Details

I. General information

NPI: 1003314675
Provider Name (Legal Business Name): EMPOWERMENT HEALTHCARE SYSTEMS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9106 PHILADELPHIA RD STE 108B
BALTIMORE MD
21237-4333
US

IV. Provider business mailing address

PO BOX 18844
BALTIMORE MD
21206-0844
US

V. Phone/Fax

Practice location:
  • Phone: 410-321-1961
  • Fax: 410-321-1962
Mailing address:
  • Phone: 410-321-1961
  • Fax: 410-321-1962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DAMIAN AYICHI
Title or Position: PRINCIPAL ASSOCIATE/CEO
Credential:
Phone: 410-321-1961