Impact Life Group Home LLC

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

IMPACT LIFE GROUP HOME LLC

Practice address

6412 Baltray Rd
Charlotte, NC 28278-6640

Phone

(704) 749-4556

NPI assigned

Feb 3, 2026

Organization subpart

No

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

Authorized official

Name

Mr. Jebolisa S Ilukwe

Title

Director

Phone

(704) 749-4556

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1770076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770076800000",
    "number": "1932059359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6412 BALTRAY RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282786640",
            "telephone_number": "704-749-4556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6412 BALTRAY RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282786640",
            "telephone_number": "704-749-4556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT LIFE GROUP HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-02-03",
        "last_updated": "2026-02-03",
        "certification_date": "2026-02-03",
        "status": "A",
        "authorized_official_last_name": "ILUKWE",
        "authorized_official_first_name": "JEBOLISA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "704-749-4556",
        "authorized_official_name_prefix": "Mr."
    },
    "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 Charlotte, NC
• Providers in Charlotte, NC by specialty
• Developmentally Disabled Services Day Training Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2026; 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.