OrganizationActive
Impact Wellness Center LLC
NPI 1093579054 · Comprehensive Outpatient Rehabilitation Facility (CORF) · Lakeside, AZ
Provider details
- NPI number
- 1093579054
- Entity type
- Organization
- Primary specialty
- Comprehensive Outpatient Rehabilitation Facility (CORF)Ambulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Charles Wade, Owner(615) 720-8088
Specialties & taxonomies
Ambulatory Health Care Facilities
Practice location
3179 W White Mountain Blvd
Lakeside, AZ 85929-6146
Phone: (615) 720-8088
Approximate (ZIP-level) locationGet directions
Mailing address
3179 W White Mountain Blvd
Lakeside, AZ 85929-6146
Registry dates
- Enumerated
- 2024-02-09
- Last updated
- 2024-05-01
- Certified
- 2024-05-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.