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General NPI Number Information
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NPI Number | 1649310301
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Entity Type | Organization
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Legal Business Name | IMPACT CENTERS, INC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 1209 TRADEWINDS DR
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City | COLUMBIA
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State | TN
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Zip | 38401-4607
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Country | US
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Telephone | 931-381-2114
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Fax |
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Provider Business Mailing Address
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Address Line | 1209 TRADEWINDS DR
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City | COLUMBIA
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State | TN
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Zip | 38401-4607
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Country | US
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Telephone | 931-381-2114
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. CINDY GRAVES
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Credential |
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Telephone | 931-381-2114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | L3(20)4M4-036-3271
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License Number State | TN
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