Provider Demographics
NPI:1154712156
Name:IMPACT MEDICAL STAFFING, INC
Entity type:Organization
Organization Name:IMPACT MEDICAL STAFFING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:AQUINO
Authorized Official - Last Name:DUNNIWAY
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:209-603-0716
Mailing Address - Street 1:193 HARP DR
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-9334
Mailing Address - Country:US
Mailing Address - Phone:209-603-0716
Mailing Address - Fax:209-599-7478
Practice Address - Street 1:193 HARP DR
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:CA
Practice Address - Zip Code:95366-9334
Practice Address - Country:US
Practice Address - Phone:209-603-0716
Practice Address - Fax:209-599-7478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9409320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities