Healthcare Provider Details

I. General information

NPI: 1598689705
Provider Name (Legal Business Name): IMPACTHOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 BYRON AVE
ANSONIA CT
06401-1301
US

IV. Provider business mailing address

9 BYRON AVE
ANSONIA CT
06401-1301
US

V. Phone/Fax

Practice location:
  • Phone: 203-644-6874
  • Fax:
Mailing address:
  • Phone: 204-644-6874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ISABELLA MYRICKS
Title or Position: OWNER
Credential:
Phone: 204-644-6874