Impact for Life Developmental Care LLC

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

IMPACT FOR LIFE DEVELOPMENTAL CARE LLC

Practice address

9541 103Rd St
1301
Jacksonville, FL 32210-0323

Phone

(904) 482-8085

NPI assigned

Mar 26, 2016

Organization subpart

No

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

Authorized official

Name

Mrs. Shenavian F Burns, RN

Title

Member Manager

Phone

(904) 482-8085

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1458950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458950400000",
    "number": "1629430848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9541 103RD ST",
            "address_2": "1301",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322100323",
            "telephone_number": "904-482-8085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9541 103RD ST",
            "address_2": "1301",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322100323",
            "telephone_number": "904-482-8085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT FOR LIFE DEVELOPMENTAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-26",
        "last_updated": "2016-03-26",
        "status": "A",
        "authorized_official_last_name": "BURNS",
        "authorized_official_first_name": "SHENAVIAN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "MEMBER MANAGER",
        "authorized_official_telephone_number": "904-482-8085",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Developmentally Disabled Services Day Training Agency in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Developmentally Disabled Services Day Training Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2016; 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.