Healthcare Provider Details

I. General information

NPI: 1336051176
Provider Name (Legal Business Name): IMPACT INTEGRATED SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6247 ORCHARD WOODS DR
WEST BLOOMFIELD MI
48324-3285
US

IV. Provider business mailing address

6247 ORCHARD WOODS DR
WEST BLOOMFIELD MI
48324-3285
US

V. Phone/Fax

Practice location:
  • Phone: 248-388-9808
  • Fax:
Mailing address:
  • Phone: 248-388-9808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: AMMAR KARANA
Title or Position: OWNER
Credential:
Phone: 248-388-9808