=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104501279
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMPOWER HOME HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2023
-----------------------------------------------------
Last Update Date | 02/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 309 W MONTGOMERY ST UNIT H
-----------------------------------------------------
City | WILLIS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77378-8649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-280-4782
-----------------------------------------------------
Fax | 936-233-8889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 309 W MONTGOMERY ST UNIT H
-----------------------------------------------------
City | WILLIS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77378-8649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-280-4782
-----------------------------------------------------
Fax | 936-233-8889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPERVISING NURSE
-----------------------------------------------------
Name | AMANDA MUDGE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-604-3416
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251F00000X
-----------------------------------------------------
Taxonomy Name | Home Infusion Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------