Provider Demographics
NPI:1043287097
Name:IMPACT COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:IMPACT COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAUBER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-640-0340
Mailing Address - Street 1:5631 NW 27TH CT
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-2397
Mailing Address - Country:US
Mailing Address - Phone:954-640-0340
Mailing Address - Fax:954-640-0344
Practice Address - Street 1:5631 NW 27TH CT
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-2397
Practice Address - Country:US
Practice Address - Phone:954-640-0340
Practice Address - Fax:954-640-0344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children