MEDICARE: SILVER IMPACT, INC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1346668811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER IMPACT, INC

Provider Business Mailing Address
First Line	:	7155 W OAKLAND PARK BLVD
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33313-1038
Country	:	US
Telephone Number	:	954-572-0444
Fax Number	:	954-572-0092

Provider Business Practice Location Address
First Line	:	7155 W OAKLAND PARK BLVD
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33313-1038
Country	:	US
Telephone Number	:	954-572-0444
Fax Number	:	954-572-0092

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ILLENE GALE GREENBERG
Credential	:	J.D.
Telephone Number	:	954-572-0444

Provider Enumeration Date	:	04/02/2014
Last Update Date	:	04/02/2014

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Directions to “SILVER IMPACT, INC ” Practice Location

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