NPIMap

Organization Active NPI

Impact Behavioral Healthcare LLC

  • Substance Abuse Rehabilitation Facility
  • Baltimore, MD
National Provider Identifier
1760197826
Registry record updated Jun 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
IMPACT BEHAVIORAL HEALTHCARE LLC
Practice address
3455 Wilkens Ave Ste 205
Baltimore, MD 21229-5265
Phone
(443) 255-9973
NPI assigned
Jan 23, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2023

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

Authorized official

Name
Mr. Muhammad Jarral
Title
Coo
Phone
(443) 255-9973

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

3455 Wilkens Ave Ste 205
Baltimore, MD 21229-5265

Mailing address

3455 Wilkens Ave Ste 205
Baltimore, MD 21229-5265
Phone (443) 255-9973

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.

Locations

3455 Wilkens Ave
Baltimore, MD 21229
Phone (410) 644-8400

NPI Registry JSON

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

{
    "created_epoch": "1674432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687219200000",
    "number": "1760197826",
    "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",
            "telephone_number": "443-255-9973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 WILKENS AVE STE 205",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212295265",
            "telephone_number": "443-255-9973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT BEHAVIORAL HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-23",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A",
        "authorized_official_last_name": "JARRAL",
        "authorized_official_first_name": "MUHAMMAD",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "443-255-9973",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "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 Jun 20, 2023; 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.