IMPACTHEALTH NPI 1952709206

NPI Information

NPI: 1952709206
Provider Name: IMPACTHEALTH
Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization
Address:
3219 N 51ST BLVD
MILWAUKEE, WI
ZIP 53216
Phone: (414) 771-0543
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IMPACTHEALTH is a community based residential treatment facility, intellectual and/or developmental disabilities in Milwaukee, WI. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. IMPACTHEALTH NPI is 1952709206. The provider is registered as an organization entity type.

The provider's business location address is:

3219 N 51ST BLVD
MILWAUKEE, WI
ZIP 53216-235
Phone: (414) 771-0543

The provider's authorized official is Yvette Johnson-towers .
The authorized official title is Directot and has the following contact phone number (414) 771-0453.

The enumeration date for this NPI number is 12/18/2014 and was last updated on 12/18/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities		101528-30	WISCONSIN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1104264001	MEDICAID	WISCONSIN
2	1073805255	MEDICAID	WISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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