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Organization
IMPACT MINDS
Active
Organization
IMPACT MINDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GHUFRAN MOHAMMAD (PRESIDENT)
(469) 831-6590
Entity
Organization
Contact information
Practice address
6118 BELGRADE AVE, DALLAS, TX 75227-3607
(469) 831-6590
Mailing address
15593 CADEMAN CT, FRISCO, TX 75035-1022
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
—
NULL
3104A0625X
Assisted Living Facility (Mental Illness)
—
NULL
310500000X
Mental Illness Intermediate Care Facility
—
NULL
311Z00000X
Custodial Care Facility
—
NULL
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
NULL
320800000X
Mental Illness Community Based Residential Treatment Facility
—
NULL
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
NULL
Other
Enumeration date
11/28/2023
Last updated
11/28/2023
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