Organization
IMPACT LIFE RESIDENTIAL CARE
Active
Other names
N/A
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLUFUNMI JOHNSON (CEO)
(804) 833-6052
Entity
Organization
Contact information
Practice address
3203 MAURY STREET, RICHMOND, VA 23224
(804) 833-6052
Mailing address
3203 MAURY ST, RICHMOND, VA 23224
(804) 833-6052
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
02/05/2025
Last updated
02/05/2025
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