Provider Demographics
NPI:1477175883
Name:IMPACT
Entity Type:Organization
Organization Name:IMPACT
Other - Org Name:COMMUNITY RESEARCH FOUNDATION
Other - Org Type:Other Name
Authorized Official - Title/Position:LEAD HR SPECIALIST -ONBOARDING
Authorized Official - Prefix:MS
Authorized Official - First Name:TESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-275-0822
Mailing Address - Street 1:1260 MORENA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3889
Mailing Address - Country:US
Mailing Address - Phone:619-232-4357
Mailing Address - Fax:
Practice Address - Street 1:1260 MORENA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3850
Practice Address - Country:US
Practice Address - Phone:619-232-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-08
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR201902804LPNOtherLICENSE PRACTICAL NURSE
CA719792OtherCALIFORNIA BOARD OF VOCATIONAL NURSING AND PSYCHIATRIC TECHNICIANS
CAVN719792OtherLICENSE VOCATIONAL NURSE