Empowerment of Divine Providence, Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

CN0030003852 Issued in GA

Legal business name

EMPOWERMENT OF DIVINE PROVIDENCE, INC.

Practice address

3 Birchfield Way
Dallas, GA 30132-0842

Phone

(404) 285-8415

NPI assigned

Sep 14, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Clorissal Liu

Title

Owner

Phone

(404) 285-8415

Specialties & licenses 4

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414713600000",
    "number": "1295017382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 BIRCHFIELD WAY",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301320842",
            "telephone_number": "404-285-8415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 BIRCHFIELD WAY",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301320842",
            "telephone_number": "404-285-8415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMPOWERMENT OF DIVINE PROVIDENCE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-14",
        "last_updated": "2014-10-31",
        "status": "A",
        "authorized_official_last_name": "LIU",
        "authorized_official_first_name": "CLORISSAL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-285-8415"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": "CN0030003852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Dallas, GA by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.