MEDICARE: HARVEST COMMUNITY IMPACT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251X00000X	Supports Brokerage Agency

General Provider Information

NPI Number	:	1073462065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARVEST COMMUNITY IMPACT

Provider Business Mailing Address
First Line	:	6748 RUNWAY AVE
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-4157
Country	:	US
Telephone Number	:	918-851-8988
Fax Number	:

Provider Business Practice Location Address
First Line	:	6748 RUNWAY AVE
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-4157
Country	:	US
Telephone Number	:	918-851-8988
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	NOVA MARIE SCOTT
Credential	:
Telephone Number	:	918-851-8988

Provider Enumeration Date	:	01/23/2026
Last Update Date	:	04/13/2026

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Directions to “HARVEST COMMUNITY IMPACT ” Practice Location

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