Impact Lives LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

IMPACT LIVES LLC

Practice address

901 S Mopac Expy Ste 300
Austin, TX 78746-5883

Phone

(512) 920-0043

Fax

(512) 375-3122

NPI assigned

Aug 3, 2023

Organization subpart

No

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

Authorized official

Name

Mr. Raoul Libam

Title

Ambr

Phone

(571) 474-8383

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1691020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710201600000",
    "number": "1619659232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 S MOPAC EXPY STE 300",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787465883",
            "telephone_number": "512-920-0043",
            "fax_number": "512-375-3122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 S MOPAC EXPY STE 300",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787465883",
            "telephone_number": "512-920-0043",
            "fax_number": "512-375-3122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT LIVES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-03",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A",
        "authorized_official_last_name": "LIBAM",
        "authorized_official_first_name": "RAOUL",
        "authorized_official_title_or_position": "AMBR",
        "authorized_official_telephone_number": "571-474-8383",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; 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.