Provider Demographics
NPI:1487885497
Name:IMPRESSION HEALTHCARE SERVICES, INC.
Entity type:Organization
Organization Name:IMPRESSION HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:SANFT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:909-709-7705
Mailing Address - Street 1:22573 BARTON RD.
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313
Mailing Address - Country:US
Mailing Address - Phone:909-514-1505
Mailing Address - Fax:909-498-1360
Practice Address - Street 1:22573 BARTON RD.
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313
Practice Address - Country:US
Practice Address - Phone:909-514-1505
Practice Address - Fax:909-498-1360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 23258320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness