1346119302 NPI number — IMPACT LIFE, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346119302 NPI number — IMPACT LIFE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMPACT LIFE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346119302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1269
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOCKESSIN
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19707-5269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22703 HURDLE DITCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARBESON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19951-2931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-485-0702
Provider Business Practice Location Address Fax Number:
302-485-9475
Provider Enumeration Date:
10/30/2025

Additional Information

Authorized Official

Authorized Official Last Name:
STEWARD
Authorized Official First Name:
LAUREN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF ADMINISTRATION
Authorized Official Telephone Number:
302-485-0702

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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