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General NPI Number Information
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NPI Number | 1770457715
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Entity Type | Organization
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Legal Business Name | IMPACT LIFE HOME HEALTH, LLC - IMPACT LIFE REHAB SERIES
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Dates
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Enumeration Date | 10/02/2025
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 9475 LOS OLMOS
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City | LOS FRESNOS
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State | TX
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Zip | 78566-4588
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Country | US
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Telephone | 956-455-5587
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Fax |
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Provider Business Mailing Address
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Address Line | 9475 LOS OLMOS
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City | LOS FRESNOS
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State | TX
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Zip | 78566-4588
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Country | US
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Telephone | 956-455-5587
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JESUS RODOLFO FLORES
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Credential | SLP
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Telephone | 956-455-5587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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