Healthcare Provider Details

I. General information

NPI: 1083205603
Provider Name (Legal Business Name): IMPACT CENTRAL FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 SILVER STAR RD
ORLANDO FL
32808-4244
US

IV. Provider business mailing address

2394 KEY AVE
SANFORD FL
32771-4601
US

V. Phone/Fax

Practice location:
  • Phone: 407-797-8625
  • Fax:
Mailing address:
  • Phone: 407-797-8625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: SASHA WASHINGTON
Title or Position: OWNER
Credential:
Phone: 407-797-8625