MEDICARE: FLOWER OF LIFE EMPOWERMENT CENTER INC

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

General Provider Information

NPI Number	:	1073288700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLOWER OF LIFE EMPOWERMENT CENTER INC

Provider Business Mailing Address
First Line	:	408 VILLA ESPANA WAY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2805
Country	:	US
Telephone Number	:	702-335-6216
Fax Number	:

Provider Business Practice Location Address
First Line	:	5423 SUNNYVILLE ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-7986
Country	:	US
Telephone Number	:	702-335-6216
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	MISS SHARON DELOIS EVANS
Credential	:	BS, QMHA
Telephone Number	:	702-335-6216

Provider Enumeration Date	:	08/13/2021
Last Update Date	:	08/13/2021

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