MEDICARE: WORTHY WELL EMPOWERED 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1083368682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WORTHY WELL EMPOWERED LLC

Provider Business Mailing Address
First Line	:	1620 E DANA DR
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-2024
Country	:	US
Telephone Number	:	605-759-8118
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 W 57TH ST STE 100
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-2255
Country	:	US
Telephone Number	:	605-335-1516
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SARAH MARIA VINING
Credential	:
Telephone Number	:	605-759-8118

Provider Enumeration Date	:	02/11/2022
Last Update Date	:	02/11/2022

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