Provider Demographics
NPI:1740032119
Name:LIFE EMPOWERMENT GROUP LLC
Entity type:Organization
Organization Name:LIFE EMPOWERMENT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ENETHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-658-9944
Mailing Address - Street 1:1024 HOLDERNESS LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-1863
Mailing Address - Country:US
Mailing Address - Phone:513-658-9944
Mailing Address - Fax:
Practice Address - Street 1:1024 HOLDERNESS LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-1863
Practice Address - Country:US
Practice Address - Phone:513-658-9944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services