Provider Demographics
NPI:1669004511
Name:IMPACT HEALTH CARE INC
Entity type:Organization
Organization Name:IMPACT HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOAYUE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:763-377-1589
Mailing Address - Street 1:1382 QUARRY LN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1330
Mailing Address - Country:US
Mailing Address - Phone:763-377-1589
Mailing Address - Fax:
Practice Address - Street 1:1382 QUARRY LN
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1330
Practice Address - Country:US
Practice Address - Phone:763-377-1589
Practice Address - Fax:844-658-3241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-09
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health