Provider Demographics
NPI:1164026480
Name:GLOBAL IMPACT GROUP LLC
Entity Type:Organization
Organization Name:GLOBAL IMPACT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KOMLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUDIFO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-480-2535
Mailing Address - Street 1:887 WASHINGTON ST STE B
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1255
Mailing Address - Country:US
Mailing Address - Phone:919-480-2535
Mailing Address - Fax:
Practice Address - Street 1:887 WASHINGTON ST STE B
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1255
Practice Address - Country:US
Practice Address - Phone:919-480-2535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
No344600000XTransportation ServicesTaxi
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker