NPI 1699589010
Impact Life Residential Care
Practice location
- Address
- 3203 Maury Street, Richmond, VA 23224
- Phone
- (804) 833-6052
- Mailing address
- 3203 Maury St, Richmond, VA 23224
Authorised official
- Name
- Olufunmi Johnson
- Title
- Ceo
- Phone
- (804) 833-6052
Registered specialties
Intellectual Disabilities Intermediate Care Facility
Primary
Registry record
- NPI
- 1699589010
- Entity type
- Organization
- NPI issued
- 5 Feb 2025
- Record last updated
- 5 Feb 2025
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.