Provider Demographics
NPI:1285315648
Name:FELICIAN IMPACT
Entity type:Organization
Organization Name:FELICIAN IMPACT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVASTANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-777-5355
Mailing Address - Street 1:260 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-2117
Mailing Address - Country:US
Mailing Address - Phone:973-777-5355
Mailing Address - Fax:
Practice Address - Street 1:258 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-2117
Practice Address - Country:US
Practice Address - Phone:973-777-5355
Practice Address - Fax:973-777-0725
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE FELICIAN SCHOOL FOR EXCEPTIONAL CHILDREN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services