Healthcare Provider Details

I. General information

NPI: 1528337326
Provider Name (Legal Business Name): IMPACT HOME IMPROVEMENTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4511 JEFFERSON DAVIS HWY
FREDERICKSBURG VA
22408-4253
US

IV. Provider business mailing address

4511 JEFFERSON DAVIS HWY
FREDERICKSBURG VA
22408-4253
US

V. Phone/Fax

Practice location:
  • Phone: 540-693-1152
  • Fax: 540-479-2714
Mailing address:
  • Phone: 540-693-1152
  • Fax: 540-479-2714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number2705-141131A
License Number StateVA

VIII. Authorized Official

Name: MR. ROBERT LOUIS JONES
Title or Position: PRESIDENT/GENERAL MANAGER
Credential:
Phone: 540-645-8097