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General NPI Number Information
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NPI Number | 1801092952
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Entity Type | Organization
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Legal Business Name | PROJECT IMPACT INC.
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 2640 INDUSTRY WAY SUITES G AND H
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City | LYNWOOD
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State | CA
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Zip | 90262-4000
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Country | US
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Telephone | 310-631-9763
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Fax | 310-631-6680
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Provider Business Mailing Address
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Address Line | 2640 INDUSTRY WAY SUITES G AND H
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City | LYNWOOD
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State | CA
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Zip | 90262-4000
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Country | US
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Telephone | 310-631-9763
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Fax | 310-631-6680
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. MATTHEW HARRIS
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Credential | D.MIN
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Telephone | 310-631-9763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MFC 18585
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License Number State | CA
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