OrganizationActive
Impact Life Residential Care
NPI 1699589010 · Intellectual Disabilities Intermediate Care Facility · Richmond, VA
Provider details
- NPI number
- 1699589010
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Olufunmi Johnson, Ceo(804) 833-6052
Specialties & taxonomies
Nursing & Custodial Care Facilities
Practice location
3203 Maury Street
Richmond, VA 23224
Phone: (804) 833-6052
Approximate (ZIP-level) locationGet directions
Mailing address
3203 Maury St
Richmond, VA 23224
Other names (DBA / former)
- Other name
- N/A
Registry dates
- Enumerated
- 2025-02-05
- Last updated
- 2025-02-05
- Certified
- 2025-01-31
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.