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General NPI Number Information
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NPI Number | 1346127420
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Entity Type | Organization
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Legal Business Name | IMPACT NETWORK
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Dates
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Enumeration Date | 08/19/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 2282 PUMALO ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-3564
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Country | US
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Telephone | 909-653-2484
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3177
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City | SAN BERNARDINO
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State | CA
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Zip | 92413-3177
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. KEITH TOLBERT
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Credential |
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Telephone | 909-478-4727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 342000000X
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Taxonomy Name | Transportation Network Company
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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Taxonomy #5
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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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