Impact Home Care Services LLC

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

IMPACT HOME CARE SERVICES LLC

Practice address

4720 Salisbury Rd
Unit 110
Jacksonville, FL 32256-6101

Phone

(904) 415-7665

NPI assigned

Feb 16, 2022

Organization subpart

No

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

Authorized official

Name

Mrs. Shawan DavisNPI 1306590385

Title

Owner

Phone

(904) 415-7665

Specialties & licenses 3

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shawan Davis

  • Developmentally Disabled Services Day Training Agency
  • Jacksonville, FL
  • NPI 1306590385

  Day Training, Developmentally Disabled Services

  NPD Authorized official

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

{
    "created_epoch": "1644969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644969600000",
    "number": "1215682505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6700 BOWDEN RD UNIT 1104",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322163672",
            "telephone_number": "904-415-7665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4720 SALISBURY RD",
            "address_2": "UNIT 110",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322566101",
            "telephone_number": "904-415-7665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT HOME CARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-16",
        "last_updated": "2022-02-16",
        "certification_date": "2022-01-31",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "SHAWAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-415-7665",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020792700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Mathew Imbt, M.D.
• Mary Imhansiemhonehi
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• Impact for Life Developmental Care LLC
• Imperial Medical Equipment LLC
• Imray & Gesek DMD PA
• In Good Company Homemaker & Companion Services LLC
• In Loving Care, LLC
• In Loving Hands Compassionate Family Home Care

• Developmentally Disabled Services Day Training Agency in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Developmentally Disabled Services Day Training Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; 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.