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General NPI Number Information
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NPI Number | 1568158152
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Entity Type | Organization
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Legal Business Name | EMPOWER RESIDENTIAL WELLNESS CENTER LLC
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Dates
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Enumeration Date | 04/17/2023
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 22119 BASSETT ST
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City | CANOGA PARK
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State | CA
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Zip | 91303-2305
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Country | US
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Telephone | 618-803-8816
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Fax | 949-281-7676
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Provider Business Mailing Address
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Address Line | 559 CHAPARRAL CT
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City | ALTADENA
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State | CA
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Zip | 91001-3859
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Country | US
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Telephone | 618-803-8816
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. BRANDON BREWER
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Credential |
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Telephone | 618-803-8816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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