Provider Demographics
NPI:1407073125
Name:IMPACT FAMILY CARE HOME INC
Entity Type:Organization
Organization Name:IMPACT FAMILY CARE HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SYVILLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRISTELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-708-5565
Mailing Address - Street 1:211 RED HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-0389
Mailing Address - Country:US
Mailing Address - Phone:919-708-5565
Mailing Address - Fax:
Practice Address - Street 1:211 RED HOLLY DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-0389
Practice Address - Country:US
Practice Address - Phone:919-708-5565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility