Healthcare Provider Details

I. General information

NPI: 1255151007
Provider Name (Legal Business Name): EMPOWER HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6524 GILDAR ST
ALEXANDRIA VA
22310-2519
US

IV. Provider business mailing address

4220 RALEIGH AVE APT 201
ALEXANDRIA VA
22304-5379
US

V. Phone/Fax

Practice location:
  • Phone: 703-300-6395
  • Fax:
Mailing address:
  • Phone: 703-300-6395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: HILINA AYALEW
Title or Position: REGISTERED NURSE
Credential:
Phone: 703-300-6395