| Impact Community Services, Llc | |
|
5366 Santa Rosa Ave Sparks NV 89436-3648 | |
| (775) 354-2421 | |
| (775) 348-6063 |
| Full Name | Impact Community Services, Llc |
|---|---|
| Speciality | Counselor |
| Location | 5366 Santa Rosa Ave, Sparks, Nevada |
| Authorized Official Name and Position | Anthony Ray Diquarto (PROGRAM DIRECTOR) |
| Authorized Official Contact | 7753517057 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Impact Community Services, Llc 5366 Santa Rosa Ave Sparks NV 89436-3648 Ph: (775) 354-2421 | Impact Community Services, Llc 5366 Santa Rosa Ave Sparks NV 89436-3648 Ph: (775) 354-2421 |
| NPI Number | 1508182106 |
|---|---|
| Provider Enumeration Date | 04/08/2010 |
| Last Update Date | 04/08/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508182106 | NPI | - | NPPES |
| 9005052160 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
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