Family Impact, Inc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

4425-125 Issued in WI

Legal business name

FAMILY IMPACT, INC

Practice address

829 S Green Bay Rd
Ste 109
Mount Pleasant, WI 53406-4058

Phone

(262) 880-5864

Fax

(262) 995-0655

NPI assigned

Oct 4, 2011

Organization subpart

No

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

Authorized official

Name

Erricka Stark, MSW, CAPSWNPI 1912307711

Title

Co-Owner/Director

Phone

(262) 635-5135

Specialties & licenses 1

Addresses

Tax ID family

Asd Impact Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Asd Impact Inc

  • Community/Behavioral Health Agency
  • Racine, WI
  • NPI 1366858292
  NPD tax ID

Locations

Practitioners 1

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

• Erricka Stark, CAPSW, BCBA

  • Behavior Analyst
  • Racine, WI
  • NPI 1912307711
  NPD (past) Authorized official

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

{
    "created_epoch": "1317686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424736000000",
    "number": "1245514520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6601 WASHINGTON AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534064058",
            "telephone_number": "262-635-5135",
            "fax_number": "262-995-7333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "829 S GREEN BAY RD",
            "address_2": "STE 109",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534064058",
            "telephone_number": "262-880-5864",
            "fax_number": "262-995-0655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY IMPACT, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-04",
        "last_updated": "2015-02-24",
        "status": "A",
        "authorized_official_last_name": "STARK",
        "authorized_official_first_name": "ERRICKA",
        "authorized_official_title_or_position": "CO-OWNER/DIRECTOR",
        "authorized_official_telephone_number": "262-635-5135",
        "authorized_official_credential": "MSW, CAPSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WI",
            "license": "4425-125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Extend Physical Therapy and Wellness
• Eye Centers of Racine and Kenosha LTD
• Eye Centers of Racine and Kenosha LTD
• Eye Clinic of Racine, LTD.
• Denise L Falaschi, LPC
• Frank C Fantazzi, PT DPT
• Farah Faridi
• Samad B Farooqi, D.O.
• Grace Faulls
• Patrick D. Fay, MD

• Community/Behavioral Health Agency in Mount Pleasant, WI
• Providers in Mount Pleasant, WI by specialty
• Community/Behavioral Health Agency in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2015; 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.