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General NPI Number Information
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NPI Number | 1649019837
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Entity Type | Organization
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Legal Business Name | EMPOWERED LIVING SOLUTIONS
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 580 RUTH AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83401-3133
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Country | US
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Telephone | 971-218-4713
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Fax |
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Provider Business Mailing Address
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Address Line | 580 RUTH AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83401-3133
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Country | US
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Telephone | 406-315-3167
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Fax | 406-315-3164
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | GWENDOLYN D BABINEAU
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Credential |
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Telephone | 406-315-3167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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