Healthcare Provider Details

I. General information

NPI: 1083549059
Provider Name (Legal Business Name): IMPACT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 COUNTY ROAD 10 STE 304K
BROOKLYN PARK MN
55429-3066
US

IV. Provider business mailing address

3300 COUNTY ROAD 10 STE 304K
MINNEAPOLIS MN
55429-3066
US

V. Phone/Fax

Practice location:
  • Phone: 763-432-9111
  • Fax: 855-930-3685
Mailing address:
  • Phone: 763-432-9111
  • Fax: 855-930-3685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DEMENIA BABYSISTER GBARBEA
Title or Position: ADMINISTRATOR
Credential: NP
Phone: 763-432-9111