Healthcare Provider Details

I. General information

NPI: 1720721608
Provider Name (Legal Business Name): IMPACT HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8551 RITCHBORO RD
DISTRICT HEIGHTS MD
20747-2646
US

IV. Provider business mailing address

8551 RITCHBORO RD
DISTRICT HEIGHTS MD
20747-2646
US

V. Phone/Fax

Practice location:
  • Phone: 240-716-0055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH AKINFIRESOYE
Title or Position: ADMINISTRATOR
Credential:
Phone: 240-716-0055