Healthcare Provider Details

I. General information

NPI: 1306630124
Provider Name (Legal Business Name): EMPOWERNEST PROVIDER CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 RIDGE ST APT 16
ORANGE NJ
07050-1649
US

IV. Provider business mailing address

71 RIDGE ST APT 16
ORANGE NJ
07050-1649
US

V. Phone/Fax

Practice location:
  • Phone: 862-306-9303
  • Fax:
Mailing address:
  • Phone: 862-306-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: TIARA BOOKER
Title or Position: OPERATOR
Credential:
Phone: 862-306-9303