Organization
EMPOWERMENT SUPPORTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AZALIA PETTWAY (OWNER)
(443) 403-9597
Entity
Organization
Contact information
Practice address
1137 CHANNEL DROP LOOP, ZEBULON, NC 27597-4432
(443) 403-9597
Mailing address
1137 CHANNEL DROP LOOP, ZEBULON, NC 27597-4432
(443) 403-9597
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
302F00000X
Exclusive Provider Organization
—
—
305R00000X
Preferred Provider Organization
—
—
385H00000X
Respite Care
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
385HR2065X
Child Physical Disabilities Respite Care
—
—
Other
Enumeration date
02/27/2025
Last updated
02/27/2025
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