Healthcare Provider Details

I. General information

NPI: 1114513942
Provider Name (Legal Business Name): EMPOWERED COMMUNITY SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNION BLVD
ENGLEWOOD OH
45322-2100
US

IV. Provider business mailing address

4205 E LAKE RD
SHEFFIELD LAKE OH
44054-1102
US

V. Phone/Fax

Practice location:
  • Phone: 937-771-0776
  • Fax:
Mailing address:
  • Phone: 440-653-5191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH KOWALSKI
Title or Position: CEO
Credential:
Phone: 937-771-0776