NPIMap

Organization Active NPI

Impact Life Corporation

  • Home Health Agency
  • Riverdale, MD
National Provider Identifier
1578226460
Registry record updated Oct 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
IMPACT LIFE CORPORATION
Practice address
6801 Kenilworth Ave Ste 300-S13
Riverdale, MD 20737-1331
Phone
(301) 792-1469
NPI assigned
Oct 18, 2021
Last updated
Oct 18, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2021

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

Authorized official

Name
Miss Olufunmi Johnson, PROVIDERNPI 1396332169
Title
Owner
Phone
(301) 792-1469

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

6801 Kenilworth Ave Ste 300-S13
Riverdale, MD 20737-1331

Mailing address

6801 Kenilworth Ave Ste 300-S13
Riverdale, MD 20737-1331
Phone (301) 792-1469

National Provider Directory

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": "1634515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634515200000",
    "number": "1578226460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6801 KENILWORTH AVE STE 300-S13",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371331",
            "telephone_number": "301-792-1469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6801 KENILWORTH AVE STE 300-S13",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371331",
            "telephone_number": "301-792-1469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT LIFE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-18",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "OLUFUNMI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-792-1469",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "PROVIDER"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverdale, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2021; 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.