NPIMap

Organization Active NPI

Impact

  • Community/Behavioral Health Agency
  • Gastonia, NC
National Provider Identifier
1194973586
Registry record updated Aug 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
795 Issued in NC
Legal business name
IMPACT
Practice address
3080 Jamestown Dr
Gastonia, NC 28054-6056
Phone
(704) 718-3480
Fax
(704) 852-4488
NPI assigned
Aug 28, 2008
Last updated
Aug 28, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2008

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

Authorized official

Name
Dr. Joseph Adedokun, PH.D.
Title
Ceo
Phone
(704) 718-3480

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 795 NC Primary

Addresses

Primary practice location

3080 Jamestown Dr
Gastonia, NC 28054-6056

Mailing address

3080 Jamestown Dr
Gastonia, NC 28054-6056
Phone (704) 718-3480

Other identifiers 1

IdentifierTypeStateIssuer
6111767MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Impact Carolina Services6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1219881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219881600000",
    "number": "1194973586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3080 JAMESTOWN DR",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280546056",
            "telephone_number": "704-718-3480",
            "fax_number": "704-852-4488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3080 JAMESTOWN DR",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280546056",
            "telephone_number": "704-718-3480",
            "fax_number": "704-852-4488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-28",
        "last_updated": "2008-08-28",
        "status": "A",
        "authorized_official_last_name": "ADEDOKUN",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-718-3480",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "795",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6111767",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2008; 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.