Healthcare Provider Details

I. General information

NPI: 1003695263
Provider Name (Legal Business Name): EMPOWERING SPACES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4927 REEDMONT LN
CHARLOTTE NC
28269-1631
US

IV. Provider business mailing address

4927 REEDMONT LN
CHARLOTTE NC
28269-1631
US

V. Phone/Fax

Practice location:
  • Phone: 980-266-2687
  • Fax:
Mailing address:
  • Phone: 980-266-2687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. LEON CARROLL SMITH JR.
Title or Position: PRESIDENT
Credential:
Phone: 980-266-2687