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Organization
IMPACT NETWORK
Active
Organization
IMPACT NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEITH TOLBERT (CEO)
(909) 478-4727
Entity
Organization
Contact information
Practice address
2282 PUMALO ST, SAN BERNARDINO, CA 92404-3564
(909) 653-2484
Mailing address
PO BOX 3177, SAN BERNARDINO, CA 92413-3177
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
NULL
251X00000X
Supports Brokerage Agency
—
NULL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
NULL
342000000X
Transportation Network Company
—
NULL
347E00000X
Transportation Broker
—
NULL
Other
Enumeration date
08/19/2025
Last updated
08/19/2025
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