Organization
IMPACT RESIDENTIAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE UWASE (OWNER)
(207) 347-1748
Entity
Organization
Contact information
Practice address
8605 TALISKER DR, AVON, IN 46123-7288
(207) 347-1748
Mailing address
8605 TALISKER DR, AVON, IN 46123-7288
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/11/2024
Last updated
10/11/2024
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