Provider Demographics
NPI:1154495562
Name:IMPACT HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:IMPACT HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:LELEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-533-3436
Mailing Address - Street 1:5901 BROOKLYN BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-2517
Mailing Address - Country:US
Mailing Address - Phone:763-533-4374
Mailing Address - Fax:
Practice Address - Street 1:5901 BROOKLYN BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-2517
Practice Address - Country:US
Practice Address - Phone:763-533-4374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN334266251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN334266OtherSTATE CLASS A LICENSE