MEDICARE: EMPOWERING INDEPENDENCE 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	253Z00000X	In Home Supportive Care Agency	232435	FL

General Provider Information

NPI Number	:	1588009294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERING INDEPENDENCE LLC

Provider Business Mailing Address
First Line	:	11386 168TH ST
Second Line	:
City	:	MC ALPIN
State	:	FL
Zip	:	32062-2360
Country	:	US
Telephone Number	:	386-364-7769
Fax Number	:	386-364-7769

Provider Business Practice Location Address
First Line	:	11386 168TH ST
Second Line	:
City	:	MC ALPIN
State	:	FL
Zip	:	32062-2360
Country	:	US
Telephone Number	:	386-364-7769
Fax Number	:	386-364-7769

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. AMI MITCHELL FIELDS
Credential	:
Telephone Number	:	386-364-7769

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	05/08/2013

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