Provider Demographics
NPI:1801972963
Name:MOMENT OF IMPACT, INC
Entity type:Organization
Organization Name:MOMENT OF IMPACT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:IMHANYIANBHO
Authorized Official - Last Name:UGIAGBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-227-4131
Mailing Address - Street 1:8456-BRUNSWICK CT N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55443
Mailing Address - Country:US
Mailing Address - Phone:763-416-0095
Mailing Address - Fax:763-515-7889
Practice Address - Street 1:8456-BRUNSWICK CT N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55443
Practice Address - Country:US
Practice Address - Phone:763-416-0095
Practice Address - Fax:763-515-7889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251E00000X, 310400000X
MN1040454-1-CFC385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered385H00000XRespite Care FacilityRespite Care