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General NPI Number Information
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NPI Number | 1043287097
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Entity Type | Organization
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Legal Business Name | IMPACT COMMUNITY SERVICES, INC.
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5631 NW 27TH CT
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City | LAUDERHILL
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State | FL
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Zip | 33313-2397
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Country | US
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Telephone | 954-640-0340
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Fax | 954-640-0344
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Provider Business Mailing Address
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Address Line | 5631 NW 27TH CT
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City | LAUDERHILL
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State | FL
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Zip | 33313-2397
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Country | US
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Telephone | 954-640-0340
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Fax | 954-640-0344
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. PAUL SCHAUBER
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Credential | LCSW
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Telephone | 954-640-0340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State | FL
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