Provider Demographics
NPI:1760246169
Name:IMPACT LIFE HOME HEALTH, LLC - HEALTHCARE SERIES
Entity Type:Organization
Organization Name:IMPACT LIFE HOME HEALTH, LLC - HEALTHCARE SERIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:RODOLFO
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-455-5587
Mailing Address - Street 1:2822 AUSTRIAN PINE CT
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7802
Mailing Address - Country:US
Mailing Address - Phone:956-455-5587
Mailing Address - Fax:
Practice Address - Street 1:9475 LOS OLMOS
Practice Address - Street 2:
Practice Address - City:LOS FRESNOS
Practice Address - State:TX
Practice Address - Zip Code:78566-4588
Practice Address - Country:US
Practice Address - Phone:956-455-5587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health