Healthcare Provider Details

I. General information

NPI: 1043287097
Provider Name (Legal Business Name): IMPACT COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5631 NW 27TH CT
LAUDERHILL FL
33313-2397
US

IV. Provider business mailing address

5631 NW 27TH CT
LAUDERHILL FL
33313-2397
US

V. Phone/Fax

Practice location:
  • Phone: 954-640-0340
  • Fax: 954-640-0344
Mailing address:
  • Phone: 954-640-0340
  • Fax: 954-640-0344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. PAUL SCHAUBER
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 954-640-0340