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Organization

EMPOWERED TO ACHIEVE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DANITRA NICOLE JACKSON (EXECUTIVE DIRECTOR)
(909) 255-0264
Entity
Organization

Contact information

Practice address
74924 COUNTRY CLUB DR., STE. 150 #101, PALM DESERT, CA 92260
(909) 255-0264
Mailing address
74924 COUNTRY CLUB DR STE 150, PALM DESERT, CA 92260-1969
(909) 255-0264

Taxonomy

Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
251B00000X
Case Management Agency
251V00000X
Voluntary or Charitable Agency

Other

Enumeration date
10/18/2025
Last updated
10/18/2025
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