Healthcare Provider Details

I. General information

NPI: 1982201562
Provider Name (Legal Business Name): EMPOWERED ASSISTED LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 10/06/2020
Certification Date: 10/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 US HIGHWAY 59 NORTH
TIMPSON TX
75975
US

IV. Provider business mailing address

719 US HIGHWAY 59 NORTH
TIMPSON TX
75975
US

V. Phone/Fax

Practice location:
  • Phone: 936-274-3050
  • Fax:
Mailing address:
  • Phone: 936-274-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. ARLISIA EVETTE STANSBERRY
Title or Position: OWNER/CEO
Credential:
Phone: 936-274-3050