Impact Healthcare Solutions LLC

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

IMPACT HEALTHCARE SOLUTIONS LLC

Practice address

1411 Highfield CT
Charlotte, NC 28216-1827

Phone

(980) 475-4730

NPI assigned

May 1, 2015

Last updated

May 1, 2015By 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. Kenneth Jermaine Crump

Title

Owner/Executive Director

Phone

(980) 475-4730

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1430438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430438400000",
    "number": "1518344217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 HIGHFIELD CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282161827",
            "telephone_number": "980-475-4730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 HIGHFIELD CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282161827",
            "telephone_number": "980-475-4730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT HEALTHCARE SOLUTIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-01",
        "last_updated": "2015-05-01",
        "status": "A",
        "authorized_official_last_name": "CRUMP",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "JERMAINE",
        "authorized_official_title_or_position": "OWNER/EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "980-475-4730",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adolescent and Children Mental Health Clinic/Center in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Adolescent and Children Mental Health Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 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.