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Organization
IMPACT ME, INCORPORATED
Active
Organization
IMPACT ME, INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SERI BOSSE (PRESIDENT)
(304) 444-9584
Entity
Organization
Contact information
Practice address
1109 HIGHLAND RD, CHARLESTON, WV 25302-3007
(130) 444-4958
Mailing address
1109 HIGHLAND RD, CHARLESTON, WV 25302-3007
(130) 444-4958
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
251300000X
Local Education Agency (LEA)
Primary
—
—
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
251V00000X
Voluntary or Charitable Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QH0100X
Health Service Clinic/Center
—
—
305R00000X
Preferred Provider Organization
—
—
310400000X
Assisted Living Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
332U00000X
Home Delivered Meals
—
—
Other
Enumeration date
05/28/2021
Last updated
11/04/2021
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