Provider Demographics
NPI:1043890122
Name:IMPACT BEHAVIORAL HEALTH AND RECOVERY CARE CORP
Entity Type:Organization
Organization Name:IMPACT BEHAVIORAL HEALTH AND RECOVERY CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCWEALTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-458-3947
Mailing Address - Street 1:1616 W SHAW AVE STE B4
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:559-570-0194
Practice Address - Street 1:1616 W SHAW AVE STE B2
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3513
Practice Address - Country:US
Practice Address - Phone:559-293-3174
Practice Address - Fax:559-570-0194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No167G00000XNursing Service ProvidersLicensed Psychiatric TechnicianGroup - Multi-Specialty