Impact Community Services, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

0167355236 Issued in VA

Legal business name

IMPACT COMMUNITY SERVICES, LLC

Practice address

10310 Memory LN
Ste. 1a
Chesterfield, VA 23832-8828

Phone

(804) 677-9456

NPI assigned

Oct 21, 2015

Last updated

Oct 21, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Torasha BlandingNPI 1922477371

Title

Owner

Phone

(804) 677-9456

Specialties & licenses 1

Addresses

Locations

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.

• Torasha Blanding

  • Case Manager/Care Coordinator
  • Chesterfield, VA
  • NPI 1922477371
  NPD (past) Authorized official

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

{
    "created_epoch": "1445385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445385600000",
    "number": "1932571668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10310 MEMORY LN",
            "address_2": "STE. 1A",
            "city": "CHESTERFIELD",
            "state": "VA",
            "postal_code": "238328828",
            "telephone_number": "804-677-9456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10310 MEMORY LN",
            "address_2": "STE. 1A",
            "city": "CHESTERFIELD",
            "state": "VA",
            "postal_code": "238328828",
            "telephone_number": "804-677-9456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT COMMUNITY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-21",
        "last_updated": "2015-10-21",
        "status": "A",
        "authorized_official_last_name": "BLANDING",
        "authorized_official_first_name": "TORASHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-677-9456"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "VA",
            "license": "0167355236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Chesterfield, VA
• Providers in Chesterfield, VA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2015; 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.