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General NPI Number Information
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NPI Number | 1902694961
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Entity Type | Organization
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Legal Business Name | EMPOWERED PATHWAYS RESIDENCE, LLC
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Dates
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Enumeration Date | 04/29/2025
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 7968 ORCHID DR
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City | EASTVALE
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State | CA
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Zip | 92880-3523
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Country | US
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Telephone | 951-818-1950
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Fax |
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Provider Business Mailing Address
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Address Line | 380 TOMPKINS CIR
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City | CORONA
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State | CA
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Zip | 92879-6103
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Country | US
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Telephone | 951-818-1950
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MRS. JULIE ROBERTS
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Credential | B.S. IN CJ
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Telephone | 951-818-1950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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