MEDICARE: IMPACT CARE 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
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1720671175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPACT CARE LLC

Provider Business Mailing Address
First Line	:	1852 FOXFIRE RD
Second Line	:
City	:	FALLBROOK
State	:	CA
Zip	:	92028-4106
Country	:	US
Telephone Number	:	951-579-9198
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 VIA VERA CRUZ STE 202
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-2632
Country	:	US
Telephone Number	:	951-579-9198
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DANA CASTLEBERRY
Credential	:
Telephone Number	:	951-579-9198

Provider Enumeration Date	:	02/17/2021
Last Update Date	:	02/17/2021

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Directions to “IMPACT CARE LLC ” Practice Location

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