Impact Wellness Center,Inc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

IMPACT WELLNESS CENTER,INC

Practice address

8991 W Flamingo Rd Ste 105
Las Vegas, NV 89147-0439

Phone

(702) 586-5001

Fax

(702) 664-0508

NPI assigned

Nov 7, 2017

Organization subpart

No

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

Authorized official

Name

Carolyn Pridgeon

Title

President/ Executive Director

Phone

(702) 586-5001

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jessie M Caracciolo

  • Community Health Worker
  • Las Vegas, NV
  • NPI 1275112781
  NPD (past)
• Leah Gardner

  • Mental Health Counselor
  • Las Vegas, NV
  • NPI 1891210977
  NPD (past)
• Tammy Renee Jackson

  • Community Health Worker
  • Las Vegas, NV
  • NPI 1558940064
  NPD (past)

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

{
    "created_epoch": "1510012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510012800000",
    "number": "1902319411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8991 W FLAMINGO RD STE 105",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891470439",
            "telephone_number": "702-586-5001",
            "fax_number": "702-664-0508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8991 W FLAMINGO RD STE 105",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891470439",
            "telephone_number": "702-586-5001",
            "fax_number": "702-664-0508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT WELLNESS CENTER,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-07",
        "last_updated": "2017-11-07",
        "status": "A",
        "authorized_official_last_name": "PRIDGEON",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_title_or_position": "PRESIDENT/ EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "702-586-5001"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ciarra Imming
• Roberta Jean Imorde
• Impact Behavioral Health, Inc
• Impact Interventions Behavioral Health Services LLC
• Impact Nation Community Services
• Imperial Excell Care Medical LLC
• Imperial Labs
• Angeligue Nicole Imperial
• Implants Dentures & Dental, Inc (Half Dental)
• Improve Hospice Inc

• Community/Behavioral Health Agency in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Community/Behavioral Health Agency in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2017; 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.