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NPI Code Detail

MEDICARE: IMPACT RESOLUTION LLC

MEDICARE: IMPACT RESOLUTION 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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1629927033
Entity Type Code : Organization
Provider Name (Legal Business Name) : IMPACT RESOLUTION LLC
Provider Business Mailing Address
First Line : 627 E 113TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44108-2602
Country : US
Telephone Number : 440-742-9478
Fax Number :
Provider Business Practice Location Address
First Line : 627 E 113TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44108-2602
Country : US
Telephone Number : 440-742-9478
Fax Number :
Authorized Official
Title or Position : OWNER
Name : ARVESHA JACKSON
Credential : LISW
Telephone Number : 440-742-9478
Provider Enumeration Date : 01/27/2026
Last Update Date : 01/27/2026

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Directions to “IMPACT RESOLUTION LLC ” Practice Location

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