Provider Demographics
NPI:1538902077
Name:EMPOWER LIVING ADULT RESIDENTIAL FACILITY, INC
Entity type:Organization
Organization Name:EMPOWER LIVING ADULT RESIDENTIAL FACILITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAQUITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITESIDE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-892-5120
Mailing Address - Street 1:2516 GRAHAM AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-2169
Mailing Address - Country:US
Mailing Address - Phone:310-892-5120
Mailing Address - Fax:
Practice Address - Street 1:828 E RADBARD ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-1516
Practice Address - Country:US
Practice Address - Phone:310-707-7553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility