Organization
IMPACT HOME CARE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHAWAN DAVIS (OWNER)
(904) 415-7665
Entity
Organization
Contact information
Practice address
4720 SALISBURY RD, UNIT 110, JACKSONVILLE, FL 32256-6101
(904) 415-7665
Mailing address
6700 BOWDEN RD UNIT 1104, JACKSONVILLE, FL 32216-3672
(904) 415-7665
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020792700
—
FL
Enumeration date
02/16/2022
Last updated
02/16/2022
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