NPIMap

Organization Active NPI

Impact Behavioral Healthcare

  • Substance Abuse Rehabilitation Facility
  • Baltimore, MD
National Provider Identifier
1740042753
Registry record updated Jan 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
IMPACT BEHAVIORAL HEALTHCARE
Practice address
3618 W Forest Park Ave
Baltimore, MD 21216-1333
Phone
(443) 449-5051
NPI assigned
Jan 25, 2024
Last updated
Jan 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2024

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

Authorized official

Name
Muhammad Ayaz JarralNPI 1033067061
Title
Ceo
Phone
(443) 255-9973

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
Substance Abuse Rehabilitation Facility 324500000X NU Primary

Addresses

Primary practice location

3618 W Forest Park Ave
Baltimore, MD 21216-1333

Mailing address

3455 Wilkens Ave Ste 205
Baltimore, MD 21229-5265

National Provider Directory

National Provider Directory
Tax ID family
Impact Behavioral Healthcare5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the 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": "1706140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706140800000",
    "number": "1740042753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3455 WILKENS AVE STE 205",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212295265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3618 W FOREST PARK AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212161333",
            "telephone_number": "443-449-5051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT BEHAVIORAL HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-25",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A",
        "authorized_official_last_name": "JARRAL",
        "authorized_official_first_name": "MUHAMMAD",
        "authorized_official_middle_name": "AYAZ",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "443-255-9973"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 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.