MEDICARE: IMPACT BEHAVIORAL HEALTHCARE

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1740042753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPACT BEHAVIORAL HEALTHCARE

Provider Business Mailing Address
First Line	:	3455 WILKENS AVE STE 205
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21229-5265
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3618 W FOREST PARK AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21216-1333
Country	:	US
Telephone Number	:	443-449-5051
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MUHAMMAD AYAZ JARRAL
Credential	:
Telephone Number	:	443-255-9973

Provider Enumeration Date	:	01/25/2024
Last Update Date	:	01/25/2024

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Directions to “IMPACT BEHAVIORAL HEALTHCARE ” Practice Location

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