Healthcare Provider Details

I. General information

NPI: 1467399469
Provider Name (Legal Business Name): IMPACT LIVES HEALTH SERVICES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 SECTION RD
CINCINNATI OH
45237-3313
US

IV. Provider business mailing address

1705 SECTION RD
CINCINNATI OH
45237-3313
US

V. Phone/Fax

Practice location:
  • Phone: 513-295-6696
  • Fax:
Mailing address:
  • Phone: 513-295-6696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KEIANA ROGERS
Title or Position: CEO
Credential: CDCA
Phone: 513-295-6696