Provider Demographics
NPI:1063141927
Name:IMPACTFUL CARE
Entity type:Organization
Organization Name:IMPACTFUL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KIPLEE
Authorized Official - Middle Name:TELETE
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:856-581-3209
Mailing Address - Street 1:923 HADDONFIELD RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2752
Mailing Address - Country:US
Mailing Address - Phone:856-581-3209
Mailing Address - Fax:856-483-8035
Practice Address - Street 1:923 HADDONFIELD RD STE 300
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2752
Practice Address - Country:US
Practice Address - Phone:856-581-3209
Practice Address - Fax:856-483-8035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0342572Medicaid