Provider Demographics
NPI:1225630486
Name:IMPACT HOSPICE CARE INC
Entity Type:Organization
Organization Name:IMPACT HOSPICE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:UCHITEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-281-7946
Mailing Address - Street 1:16430 VENTURA BLVD STE 200A
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2135
Mailing Address - Country:US
Mailing Address - Phone:818-281-7946
Mailing Address - Fax:855-662-7926
Practice Address - Street 1:16430 VENTURA BLVD STE 200A
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2135
Practice Address - Country:US
Practice Address - Phone:818-281-7946
Practice Address - Fax:855-662-7926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based