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General NPI Number Information
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NPI Number | 1346833647
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Entity Type | Organization
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Legal Business Name | IMPACT 360
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Dates
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Enumeration Date | 02/17/2021
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 2601 CARTWRIGHT RD # D233
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City | MISSOURI CITY
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State | TX
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Zip | 77459-2613
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Country | US
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Telephone | 281-241-9183
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 CARTWRIGHT RD # D233
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City | MISSOURI CITY
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State | TX
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Zip | 77459-2613
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Country | US
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Telephone | 281-241-9183
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Fax |
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | EBONI ZANDRANETTE DAVIS
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Credential |
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Telephone | 281-241-9183
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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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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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