Healthcare Provider Details

I. General information

NPI: 1376317792
Provider Name (Legal Business Name): EMPOWERMENT BEHAVIORAL THERAPEUTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6475 NEW HAMPSHIRE AVE STE C700
HYATTSVILLE MD
20783-3269
US

IV. Provider business mailing address

6475 NEW HAMPSHIRE AVE STE C700
HYATTSVILLE MD
20783-3269
US

V. Phone/Fax

Practice location:
  • Phone: 215-801-7893
  • Fax:
Mailing address:
  • Phone: 215-801-7893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID RYAN SHRANK
Title or Position: OWNER
Credential: LCSWC
Phone: 240-565-2558