Organization
IMPACT TRANSIT SERVICE
Active
Organization
IMPACT TRANSIT SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RASBY G MASON II (OWNER)
(318) 349-9394
Entity
Organization
Contact information
Practice address
4727 BROADWAY AVE, SHREVEPORT, LA 71109-6908
(318) 349-9394
(318) 470-4636
Mailing address
1007 GOULD DRIVE, BUILDING 1 SUITE 1, BOSIER CITY, LA 71111
(318) 349-9394
(318) 626-7179
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261Q00000X
Clinic/Center
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
261QV0200X
VA Clinic/Center
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
08/09/2024
Last updated
09/09/2024
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