Impact Community Services, LLC

Primary specialty

CounselorTaxonomy code 101Y00000X

Legal business name

IMPACT COMMUNITY SERVICES, LLC

Practice address

5366 Santa Rosa Ave
Sparks, NV 89436-3648

Phone

(775) 354-2421

Fax

(775) 348-6063

NPI assigned

Apr 8, 2010

Last updated

Apr 8, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Anthony Ray Diquarto, B.A.

Title

Program Director

Phone

(775) 351-7057

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1270684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270684800000",
    "number": "1508182106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5366 SANTA ROSA AVE",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894363648",
            "telephone_number": "775-354-2421",
            "fax_number": "775-348-6063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5366 SANTA ROSA AVE",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894363648",
            "telephone_number": "775-354-2421",
            "fax_number": "775-348-6063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT COMMUNITY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-08",
        "last_updated": "2010-04-08",
        "status": "A",
        "authorized_official_last_name": "DIQUARTO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "775-351-7057",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "B.A."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9005052160",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Counselor in Sparks, NV
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• Counselor in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2010; 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.