MEDICARE: EMPOWERING FAMILIES 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	S4757185	VA

General Provider Information

NPI Number	:	1073049946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERING FAMILIES LLC

Provider Business Mailing Address
First Line	:	5215 COLLEY AVE
Second Line	:	121
City	:	NORFOLK
State	:	VA
Zip	:	23508-2166
Country	:	US
Telephone Number	:	757-918-5481
Fax Number	:

Provider Business Practice Location Address
First Line	:	5215 COLLEY AVE
Second Line	:	121
City	:	NORFOLK
State	:	VA
Zip	:	23508-2166
Country	:	US
Telephone Number	:	757-918-5481
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DHAIMA MARTIN
Credential	:
Telephone Number	:	757-918-5481

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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