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General NPI Number Information
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NPI Number | 1255856993
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Entity Type | Organization
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Legal Business Name | IMPACT MANAGEMENT SERVICES, LLC
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 8240 CUMBERLAND RD
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City | NEW KENT
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State | VA
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Zip | 23124-2010
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Country | US
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Telephone | 804-966-8686
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Fax | 804-966-5009
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Provider Business Mailing Address
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Address Line | 8240 CUMBERLAND RD
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City | NEW KENT
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State | VA
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Zip | 23124-2010
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Country | US
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Telephone | 804-966-8686
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Fax | 804-966-5009
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. SAMUEL JEFFERSON JR.
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Credential |
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Telephone | 804-397-9924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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