Provider Demographics
NPI:1023486511
Name:IMPULSE SUPPORT CARE LLC
Entity type:Organization
Organization Name:IMPULSE SUPPORT CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDRAE
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:GIVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-815-4455
Mailing Address - Street 1:295 MADISON AVE FL 12
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6379
Mailing Address - Country:US
Mailing Address - Phone:917-815-4455
Mailing Address - Fax:
Practice Address - Street 1:295 MADISON AVE FL 12
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6379
Practice Address - Country:US
Practice Address - Phone:917-815-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency