Healthcare Provider Details

I. General information

NPI: 1447128087
Provider Name (Legal Business Name): IMPACT COMMUNITY ECONOMIC DEVELOPMENT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2404 LINCOLN WAY W
SOUTH BEND IN
46628-1916
US

IV. Provider business mailing address

2201 TOLEDO RD
ELKHART IN
46516-5771
US

V. Phone/Fax

Practice location:
  • Phone: 574-366-0801
  • Fax:
Mailing address:
  • Phone: 574-216-3497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWIN A NEWSOME
Title or Position: CEO
Credential:
Phone: 574-216-3497