MEDICARE: IMPACT4LIFE SERVICES 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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1770324469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPACT4LIFE SERVICES LLC

Provider Business Mailing Address
First Line	:	4337 E 30TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-3103
Country	:	US
Telephone Number	:	317-517-3713
Fax Number	:

Provider Business Practice Location Address
First Line	:	4337 E 30TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-3103
Country	:	US
Telephone Number	:	317-517-3713
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PATRICIA ANN GERMANY
Credential	:
Telephone Number	:	317-517-3713

Provider Enumeration Date	:	06/05/2024
Last Update Date	:	06/05/2024

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