Impact Life Residential Care

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

IMPACT LIFE RESIDENTIAL CARE

Practice address

3203 Maury Street
Richmond, VA 23224

Phone

(804) 833-6052

NPI assigned

Feb 5, 2025

Organization subpart

No

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

Authorized official

Name

Dr. Olufunmi Johnson

Title

Ceo

Phone

(804) 833-6052

Specialties & licenses 1

Addresses

Other names 1

• N/A Other name

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

{
    "created_epoch": "1738713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738713600000",
    "number": "1699589010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3203 MAURY ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "23224",
            "telephone_number": "804-833-6052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3203 MAURY STREET",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "23224",
            "telephone_number": "804-833-6052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT LIFE RESIDENTIAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-05",
        "last_updated": "2025-02-05",
        "certification_date": "2025-01-31",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "OLUFUNMI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "804-833-6052",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "N/A",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kimberly M Imajo, AU.D.
• Imani Healthcare Services Inc.
• Terence Alfred Imbery, D.D.S
• Hal Irwin Imburg, LPC
• Immediate MD, PLLC
• Impact on Youth Services, LLC
• Impact Youth Services, LLC
• Improve ABA of VA LLC
• Impulse Transport LLC
• In Good Hands Residential LLC

• Intellectual Disabilities Intermediate Care Facility in Richmond, VA
• Providers in Richmond, VA by specialty
• Intellectual Disabilities Intermediate Care Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2025; 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.