Provider Demographics
NPI:1417512179
Name:IMPACT HOME CARE SOLUTIONS LLC
Entity Type:Organization
Organization Name:IMPACT HOME CARE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:954-817-9532
Mailing Address - Street 1:1211 TECH BLVD STE 145
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-7845
Mailing Address - Country:US
Mailing Address - Phone:813-995-8890
Mailing Address - Fax:
Practice Address - Street 1:1211 TECH BLVD STE 145
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-7845
Practice Address - Country:US
Practice Address - Phone:813-995-8890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health