Healthcare Provider Details

I. General information

NPI: 1689245979
Provider Name (Legal Business Name): IMPRESSIVE HANDS HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1198 NEWVILLE RD
CARLISLE PA
17013-1739
US

IV. Provider business mailing address

1198 NEWVILLE RD
CARLISLE PA
17013-1739
US

V. Phone/Fax

Practice location:
  • Phone: 347-423-7366
  • Fax:
Mailing address:
  • Phone: 347-423-7366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. TAWANA L HARRIS
Title or Position: CEO/ MANAGER
Credential:
Phone: 347-423-7366