Organization
EMPOWERMENT BEHAVIORAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH J MIMS (OWNER/PROGRAM DIRECTOR)
(602) 507-0320
Entity
Organization
Contact information
Practice address
6448 W COLTER ST, GLENDALE, AZ 85301-6527
(623) 206-0557
Mailing address
6448 W COLTER ST, GLENDALE, AZ 85301-6527
(623) 206-0557
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/28/2019
Last updated
03/28/2019
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