Provider Demographics
NPI:1285330407
Name:PROJECT IMPACT INC.
Entity type:Organization
Organization Name:PROJECT IMPACT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-631-9763
Mailing Address - Street 1:2640 INDUSTRY WAY
Mailing Address - Street 2:SUITES G AND H
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-4000
Mailing Address - Country:US
Mailing Address - Phone:310-631-9763
Mailing Address - Fax:310-631-6680
Practice Address - Street 1:2640 INDUSTRY WAY
Practice Address - Street 2:SUITES G AND H
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-4000
Practice Address - Country:US
Practice Address - Phone:310-631-9763
Practice Address - Fax:310-631-6680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)