Provider Demographics
NPI:1487729075
Name:IMPACT HOME CARE SERVICES
Entity type:Organization
Organization Name:IMPACT HOME CARE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LASHONDA
Authorized Official - Middle Name:SWINDELL
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:910-276-4644
Mailing Address - Street 1:PO BOX 2076
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28353-2076
Mailing Address - Country:US
Mailing Address - Phone:910-276-4644
Mailing Address - Fax:910-276-4717
Practice Address - Street 1:213 W CRONLY ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-3637
Practice Address - Country:US
Practice Address - Phone:910-276-4644
Practice Address - Fax:910-276-4717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC 3044251E00000X
NCHC2556251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408410Medicaid
NC6601101Medicaid
NC6601319Medicaid