Basic Information
| Provider Information | |||||||||
| NPI: | 1992889562 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMPOWERMENT RESOURCE ASSOCIATES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1733 SPRING GARDEN ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191303915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155640680 | ||||||||
| FaxNumber: | 2155640680 | ||||||||
| Practice Location | |||||||||
| Address1: | 1733 SPRING GARDEN ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191303915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155640680 | ||||||||
| FaxNumber: | 2155640680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 07/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | HENDERSON | ||||||||
| AuthorizedOfficialFirstName: | JUDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECTIVE DIRECTOR AND PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2155640680 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MHS, MS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 132910 | PA | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 01791830 | 01 | PA | DEPT. OF PUBLIC WELFARE | OTHER |