Healthcare Provider Details

I. General information

NPI: 1215618277
Provider Name (Legal Business Name): EMPOWERED HEALTH ADULT DAY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5797 BEECHCROFT RD STE F
COLUMBUS OH
43229-2758
US

IV. Provider business mailing address

5817 BEECHCROFT RD
COLUMBUS OH
43229-3877
US

V. Phone/Fax

Practice location:
  • Phone: 614-291-8592
  • Fax: 614-392-0051
Mailing address:
  • Phone: 614-291-8592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: KIMIKA M JACKSON
Title or Position: OWNER
Credential:
Phone: 614-778-0815