Healthcare Provider Details

I. General information

NPI: 1306478854
Provider Name (Legal Business Name): 180 DEGREES EMPOWERMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 HIGH ST STE C
BROWNSVILLE PA
15417-2164
US

IV. Provider business mailing address

751 HIGH ST STE C
BROWNSVILLE PA
15417-2164
US

V. Phone/Fax

Practice location:
  • Phone: 724-208-9963
  • Fax:
Mailing address:
  • Phone: 724-208-9963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. WENDELL BATES
Title or Position: CHIEF OPERATING OFFICER
Credential: MSHS
Phone: 877-829-5500