Organization
IMPACT LIVES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAOUL LIBAM (AMBR)
(571) 474-8383
Entity
Organization
Contact information
Practice address
901 S MOPAC EXPY STE 300, AUSTIN, TX 78746-5883
(512) 920-0043
(512) 375-3122
Mailing address
901 S MOPAC EXPY STE 300, AUSTIN, TX 78746-5883
(512) 920-0043
(512) 375-3122
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
3747P1801X
Personal Care Attendant
—
—
Other
Enumeration date
08/03/2023
Last updated
03/12/2024
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