Provider Demographics
NPI:1487361358
Name:SISTA EMPOWHER
Entity type:Organization
Organization Name:SISTA EMPOWHER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KETLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEOPHAS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:754-303-8480
Mailing Address - Street 1:11797 SW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3791
Mailing Address - Country:US
Mailing Address - Phone:754-303-8480
Mailing Address - Fax:
Practice Address - Street 1:11797 SW 16TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-3791
Practice Address - Country:US
Practice Address - Phone:754-303-8480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No282J00000XHospitalsReligious Nonmedical Health Care Institution
No174200000XOther Service ProvidersMeals
No251300000XAgenciesLocal Education Agency (LEA)