Provider Demographics
NPI:1013555440
Name:INTELLECTUAL IMPRESSIONS LLC
Entity Type:Organization
Organization Name:INTELLECTUAL IMPRESSIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HAWTHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:419-973-7424
Mailing Address - Street 1:7813 BEULAH CHURCH RD UNIT 110
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40228-1773
Mailing Address - Country:US
Mailing Address - Phone:419-973-7424
Mailing Address - Fax:
Practice Address - Street 1:7813 BEULAH CHURCH RD UNIT 110
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40228-1773
Practice Address - Country:US
Practice Address - Phone:419-973-7424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health