Provider Demographics
NPI:1851089254
Name:IMPACT NATION COMMUNITY SERVICES
Entity Type:Organization
Organization Name:IMPACT NATION COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:ZAKARI
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-230-1844
Mailing Address - Street 1:900 S VALLEY VIEW BLVD STE 195
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-4430
Mailing Address - Country:US
Mailing Address - Phone:725-230-1844
Mailing Address - Fax:800-520-8116
Practice Address - Street 1:900 S VALLEY VIEW BLVD STE 195
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-4430
Practice Address - Country:US
Practice Address - Phone:725-230-1844
Practice Address - Fax:800-520-8116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health