Organization
IMPACT LIFE CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS OLUFUNMI JOHNSON PROVIDER (OWNER)
(301) 792-1469
Entity
Organization
Contact information
Practice address
6801 KENILWORTH AVE STE 300-S13, RIVERDALE, MD 20737-1331
(301) 792-1469
Mailing address
6801 KENILWORTH AVE STE 300-S13, RIVERDALE, MD 20737-1331
(301) 792-1469
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
10/18/2021
Last updated
10/18/2021
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