MEDICARE: IMPACT HOME CARE SOLUTIONS LLC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1417512179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPACT HOME CARE SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	1211 TECH BLVD STE 145
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-7845
Country	:	US
Telephone Number	:	813-995-8890
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 TECH BLVD STE 145
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-7845
Country	:	US
Telephone Number	:	813-995-8890
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MELISSA ROBERTS
Credential	:	APRN
Telephone Number	:	954-817-9532

Provider Enumeration Date	:	05/07/2019
Last Update Date	:	05/07/2019

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Directions to “IMPACT HOME CARE SOLUTIONS LLC ” Practice Location

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