Healthcare Provider Details

I. General information

NPI: 1184053621
Provider Name (Legal Business Name): EMPOWERMENT HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 GRAND MONTECITO PKWY UNIT 3063
LAS VEGAS NV
89149-0282
US

IV. Provider business mailing address

7100 GRAND MONTECITO PKWY UNIT 3063
LAS VEGAS NV
89149-0282
US

V. Phone/Fax

Practice location:
  • Phone: 702-578-3035
  • Fax: 702-974-1342
Mailing address:
  • Phone: 702-578-3035
  • Fax: 702-974-1342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberNV20131618755
License Number StateNV

VIII. Authorized Official

Name: DAMON STERLING MATTISON JR.
Title or Position: CEO
Credential:
Phone: 702-578-3035