Provider Demographics
NPI:1538930037
Name:CARE IMPACT 4, LLC
Entity type:Organization
Organization Name:CARE IMPACT 4, LLC
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:OTR/L
Authorized Official - Phone:804-677-0415
Mailing Address - Street 1:5100 FILLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-5069
Mailing Address - Country:US
Mailing Address - Phone:703-845-5013
Mailing Address - Fax:
Practice Address - Street 1:5100 FILLMORE AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-5069
Practice Address - Country:US
Practice Address - Phone:703-845-5013
Practice Address - Fax:703-845-2976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health