Provider Demographics
NPI:1609658160
Name:IMPACT FAMILY SERVICES LLC
Entity Type:Organization
Organization Name:IMPACT FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-821-2458
Mailing Address - Street 1:316 N PEARL ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-6505
Mailing Address - Country:US
Mailing Address - Phone:815-821-2458
Mailing Address - Fax:
Practice Address - Street 1:316 N PEARL ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-6505
Practice Address - Country:US
Practice Address - Phone:815-821-2458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child