Provider Demographics
NPI:1174135081
Name:AGENCY IMPACT INC
Entity type:Organization
Organization Name:AGENCY IMPACT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:R
Authorized Official - Last Name:AGOSTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-961-1300
Mailing Address - Street 1:4555 KINTZ DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-9045
Mailing Address - Country:US
Mailing Address - Phone:317-675-0401
Mailing Address - Fax:
Practice Address - Street 1:2204 DUKE ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2238
Practice Address - Country:US
Practice Address - Phone:317-961-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management