MEDICARE: SUPPORTIVE EMPOWERMENT HOUSE CORPORATION

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1942157904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPPORTIVE EMPOWERMENT HOUSE CORPORATION

Provider Business Mailing Address
First Line	:	4217 NW 37TH TER
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33309-4149
Country	:	US
Telephone Number	:	305-879-1828
Fax Number	:

Provider Business Practice Location Address
First Line	:	4217 NW 37TH TER
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33309-4149
Country	:	US
Telephone Number	:	305-879-1828
Fax Number	:

Authorized Official
Title or Position	:	OWNER / AUTHORIZED OFFICIAL
Name	:	ROSE MARIE CECILE DYER
Credential	:	LPN
Telephone Number	:	305-879-1828

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

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