Healthcare Provider Details

I. General information

NPI: 1770029696
Provider Name (Legal Business Name): EMPOWERED LIVING HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 LITTLEBROOK DR
FAIRFIELD OH
45014-1524
US

IV. Provider business mailing address

158 LITTLEBROOK DR
FAIRFIELD OH
45014-1524
US

V. Phone/Fax

Practice location:
  • Phone: 513-410-5008
  • Fax:
Mailing address:
  • Phone: 513-410-5008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: LACRETIA A ANCONA
Title or Position: CEO
Credential:
Phone: 513-410-5008