MEDICARE: EMPOWERED LIVING 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	3104A0625X	Assisted Living Facility (Mental Illness)

General Provider Information

NPI Number	:	1346196409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERED LIVING LLC

Provider Business Mailing Address
First Line	:	17884 FIELDING CT
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-2000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17884 FIELDING CT
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-2000
Country	:	US
Telephone Number	:	952-649-5585
Fax Number	:

Authorized Official
Title or Position	:	OWNER / DIRECTOR
Name	:	FARHAN HUSEN
Credential	:
Telephone Number	:	952-649-5585

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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