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General NPI Number Information
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NPI Number | 1053104018
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Entity Type | Organization
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Legal Business Name | IIMPACT, NFP
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 6011 S JUSTINE ST
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City | CHICAGO
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State | IL
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Zip | 60636-2307
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Country | US
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Telephone | 312-857-3838
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Fax |
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Provider Business Mailing Address
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Address Line | 333 S WABASH AVE STE 2700
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City | CHICAGO
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State | IL
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Zip | 60604-4129
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Country | US
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Telephone | 312-978-3038
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LACOYA HARRIS
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Credential |
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Telephone | 312-978-3038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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