Healthcare Provider Details

I. General information

NPI: 1073051553
Provider Name (Legal Business Name): IMPACT HEALTH MANAGEMENT SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11120 N BAYOU VIEW DR
GONZALES LA
70737-6560
US

IV. Provider business mailing address

11120 N BAYOU VIEW DR
GONZALES LA
70737-6560
US

V. Phone/Fax

Practice location:
  • Phone: 225-590-6821
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: NICOLE ISAAC THOMAS
Title or Position: OWNER
Credential: MSN, RN, CCM
Phone: 225-590-6821