Impact Outpatient Program LLC
Organization Active NPI Substance Abuse Rehabilitation Facility · Mt Washington, KY
NPI 1972176113 · NPPES record last updated Sep 2, 2025
Key facts
- NPI
- 1972176113
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Abuse Rehabilitation Facility 324500000X
- Legal business name
- IMPACT OUTPATIENT PROGRAM LLC
- Practice address
- 1200 N Bardstown Rd Ste A2
Mt Washington, KY 40047-7669 - Phone
- (502) 439-2248
- NPI assigned
- Jul 23, 2021
- Organization subpart
- No
Authorized official
- Name
- Brian Thornsberry
- Title
- Manager
- Phone
- (502) 439-2248
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D2305810 | Impact Outpatient Program, LLC | Certificate of waiver | Jun 5, 2028 |
National Provider Directory
Locations
1200 N Bardstown Rd
Ste A2
Mt Washington, KY 40047
Phone (502) 439-2248
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Abuse Rehabilitation Facility | 324500000X | Yes |
Addresses
Primary practice location
1200 N Bardstown Rd Ste A2
Mt Washington, KY 40047-7669
Mailing address
1200 N Bardstown Rd Ste A2
Mt Washington, KY 40047-7669
Other names
- ROBERT ALEXANDER CENTER FOR RECOVERY
Other providers in Mt Washington, KY
- Katelyn Renee Hopper
- Taylor Horn
- Kayla Huff
- Karen Anne Hughes
- Kimberley Marie Huseman
- Nita Suzann Isgrigg
- Linda S Jasper
- Susan J Jensen
- Nathanial Johnson
- Joseph Geraci DMD PLLC
All providers in Mt Washington, KY · Substance Abuse Rehabilitation Facility in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 2, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.