MEDICARE: EMPOWERMENT EMPLOYMENT 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

General Provider Information

NPI Number	:	1386011427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERMENT EMPLOYMENT SERVICES, LLC

Provider Business Mailing Address
First Line	:	4516 S 700 E
Second Line	:	SUITE 170
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-4192
Country	:	US
Telephone Number	:	801-979-1480
Fax Number	:

Provider Business Practice Location Address
First Line	:	4516 S 700 E
Second Line	:	SUITE 170
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-4192
Country	:	US
Telephone Number	:	801-979-1480
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROXANE DURTSCHI
Credential	:
Telephone Number	:	801-979-1480

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	08/24/2015

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