Impact Communtiy Service LLC

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

GF125403151 Issued in NV

Legal business name

IMPACT COMMUNTIY SERVICE LLC

Practice address

9801 Crystalline Dr
Reno, NV 89506-7566

Phone

(775) 677-2640

NPI assigned

Mar 2, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Donald Wade Skipper

Title

Basic Skills Trainer

Phone

(775) 378-6722

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1299024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299024000000",
    "number": "1184922916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9801 CRYSTALLINE DR",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895067566",
            "telephone_number": "775-677-2640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9801 CRYSTALLINE DR",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895067566",
            "telephone_number": "775-677-2640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT COMMUNTIY SERVICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-02",
        "last_updated": "2011-03-02",
        "status": "A",
        "authorized_official_last_name": "SKIPPER",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WADE",
        "authorized_official_title_or_position": "BASIC SKILLS TRAINER",
        "authorized_official_telephone_number": "775-378-6722",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NV",
            "license": "GF125403151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Reno, NV by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.