NPIMap

Organization Active NPI

Asd Impact Inc

  • Community/Behavioral Health Agency
  • Racine, WI
National Provider Identifier
1366858292
Registry record updated Jul 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
128554121 Issued in WI
Legal business name
ASD IMPACT INC
Practice address
6601 Washington Ave
Racine, WI 53406-3923
Phone
(262) 880-5864
NPI assigned
Jul 11, 2014
Last updated
Jul 11, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2014

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

Authorized official

Name
Erricka Border
Title
Owner
Phone
(262) 880-5864

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 128554121 WI Primary

Addresses

Primary practice location

6601 Washington Ave
Racine, WI 53406-3923

Mailing address

1017 Stratford CT
Racine, WI 53406-7001

National Provider Directory

National Provider Directory
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.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1405036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405036800000",
    "number": "1366858292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1017 STRATFORD CT",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534067001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 WASHINGTON AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534063923",
            "telephone_number": "262-880-5864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASD IMPACT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-11",
        "last_updated": "2014-07-11",
        "status": "A",
        "authorized_official_last_name": "BORDER",
        "authorized_official_first_name": "ERRICKA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-880-5864"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WI",
            "license": "128554121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Racine, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2014; 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.