Provider Demographics
NPI:1275303307
Name:CARE IMPACT PLUS ROANOKE
Entity Type:Organization
Organization Name:CARE IMPACT PLUS ROANOKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:RAUSCHENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-905-7257
Mailing Address - Street 1:2847 PENN FOREST BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4373
Mailing Address - Country:US
Mailing Address - Phone:540-774-4433
Mailing Address - Fax:
Practice Address - Street 1:2847 PENN FOREST BLVD STE 201
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4373
Practice Address - Country:US
Practice Address - Phone:540-774-4433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARE IMPACT 1 LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health