Provider Demographics
NPI:1427624634
Name:IMPACT ME, INCORPORATED
Entity type:Organization
Organization Name:IMPACT ME, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SERI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-444-9584
Mailing Address - Street 1:1109 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-3007
Mailing Address - Country:US
Mailing Address - Phone:130-444-4958
Mailing Address - Fax:
Practice Address - Street 1:1109 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3007
Practice Address - Country:US
Practice Address - Phone:130-444-4958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-28
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251300000XAgenciesLocal Education Agency (LEA)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or CharitableGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No332U00000XSuppliersHome Delivered Meals