Provider Demographics
NPI:1043962889
Name:IMPACT CARE SERVICES LLC
Entity Type:Organization
Organization Name:IMPACT CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:FEQUIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-370-8248
Mailing Address - Street 1:2020 BRICE RD STE 185
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-3484
Mailing Address - Country:US
Mailing Address - Phone:614-600-5530
Mailing Address - Fax:
Practice Address - Street 1:2020 BRICE RD STE 185
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-3484
Practice Address - Country:US
Practice Address - Phone:614-600-5530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health