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General NPI Number Information
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NPI Number | 1720584642
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Entity Type | Organization
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Legal Business Name | IMPACT SUPPORT SERVICES, INC.
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Dates
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Enumeration Date | 03/30/2018
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Last Update Date | 03/30/2018
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Provider Practice Location Address
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Address Line | 4500 FORBES BLVD STE 200-E
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City | LANHAM
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State | MD
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Zip | 20706-6312
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Country | US
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Telephone | 203-675-3225
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Fax |
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Provider Business Mailing Address
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Address Line | 10602 HEATHER GLEN WAY
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City | BOWIE
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State | MD
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Zip | 20720-4279
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Country | US
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Telephone | 203-675-3225
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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 | AMARA UZOMAH
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Credential |
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Telephone | 203-675-3225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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