Provider Demographics
NPI:1740283282
Name:COMMUNITY IMPACT, INC.
Entity type:Organization
Organization Name:COMMUNITY IMPACT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:MYLES
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:513-319-3325
Mailing Address - Street 1:700 W PETE ROSE WAY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45203-1875
Mailing Address - Country:US
Mailing Address - Phone:513-319-3325
Mailing Address - Fax:
Practice Address - Street 1:700 W PETE ROSE WAY
Practice Address - Street 2:SUITE 350
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45203-1892
Practice Address - Country:US
Practice Address - Phone:513-319-3325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-29
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or CharitableGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500672145Medicaid
MS09783781Medicaid
OH005406Medicaid