Provider Demographics
NPI:1255856993
Name:IMPACT MANAGEMENT SERVICES, LLC
Entity Type:Organization
Organization Name:IMPACT MANAGEMENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:804-397-9924
Mailing Address - Street 1:8240 CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:NEW KENT
Mailing Address - State:VA
Mailing Address - Zip Code:23124-2010
Mailing Address - Country:US
Mailing Address - Phone:804-966-8686
Mailing Address - Fax:804-966-5009
Practice Address - Street 1:8240 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:NEW KENT
Practice Address - State:VA
Practice Address - Zip Code:23124-2010
Practice Address - Country:US
Practice Address - Phone:804-966-8686
Practice Address - Fax:804-966-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management