Provider Demographics
NPI:1255542981
Name:IMPAC COMMUNITY DEVELOPMENT, INC
Entity type:Organization
Organization Name:IMPAC COMMUNITY DEVELOPMENT, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:TROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-375-2100
Mailing Address - Street 1:499 N STATE ROAD 434
Mailing Address - Street 2:SUITE 2059
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2142
Mailing Address - Country:US
Mailing Address - Phone:407-375-2100
Mailing Address - Fax:407-682-0204
Practice Address - Street 1:499 N STATE ROAD 434
Practice Address - Street 2:SUITE 2059
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2142
Practice Address - Country:US
Practice Address - Phone:407-375-2100
Practice Address - Fax:407-682-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment