Provider Demographics
NPI:1720584642
Name:IMPACT SUPPORT SERVICES, INC.
Entity Type:Organization
Organization Name:IMPACT SUPPORT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:UZOMAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-675-3225
Mailing Address - Street 1:10602 HEATHER GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4279
Mailing Address - Country:US
Mailing Address - Phone:203-675-3225
Mailing Address - Fax:
Practice Address - Street 1:4500 FORBES BLVD STE 200-E
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-6312
Practice Address - Country:US
Practice Address - Phone:203-675-3225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services