| Impact Lives Health Service | |
|
1045 Taylor Ave Ste 206 Baltimore MD 21286-8316 | |
| (443) 963-2602 | |
| Not Available |
| Full Name | Impact Lives Health Service |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1045 Taylor Ave Ste 206, Baltimore, Maryland |
| Authorized Official Name and Position | Michael Westbrook (C.E.O.) |
| Authorized Official Contact | 4109632602 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Impact Lives Health Service Po Box 11462 Baltimore MD 21239-0462 Ph: (410) 963-2602 | Impact Lives Health Service 1045 Taylor Ave Ste 206 Baltimore MD 21286-8316 Ph: (443) 963-2602 |
| NPI Number | 1326710443 |
|---|---|
| Provider Enumeration Date | 09/28/2021 |
| Last Update Date | 09/29/2022 |
| Certification Date | 09/29/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326710443 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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