Healthcare Provider Details

I. General information

NPI: 1396293346
Provider Name (Legal Business Name): EMPOWER RECOVERY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 3RD AVE SE
PINE CITY MN
55063-1508
US

IV. Provider business mailing address

645 3RD AVENUE SW
PINE CITY MN
55063
US

V. Phone/Fax

Practice location:
  • Phone: 320-629-0059
  • Fax: 320-629-9983
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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: CHERYL ANN SCHMIDT
Title or Position: OWNER
Credential:
Phone: 320-629-0059