MEDICARE: EMPOWERMENT INTERVENTION SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1003511635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERMENT INTERVENTION SERVICES LLC

Provider Business Mailing Address
First Line	:	1430 STRICKLAND ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75216-1314
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1430 STRICKLAND ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75216-1314
Country	:	US
Telephone Number	:	804-647-9292
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LATONIA GRIMES
Credential	:
Telephone Number	:	804-647-9292

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	04/03/2023

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