Healthcare Provider Details

I. General information

NPI: 1780510214
Provider Name (Legal Business Name): TEAM IMPACT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 W 103RD AVE
FEDERAL HEIGHTS CO
80260-8600
US

IV. Provider business mailing address

2800 W 103RD AVE
FEDERAL HEIGHTS CO
80260-8600
US

V. Phone/Fax

Practice location:
  • Phone: 720-298-6307
  • Fax:
Mailing address:
  • Phone: 720-298-6307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA LOPEZ
Title or Position: CFO
Credential:
Phone: 720-298-6307