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IMPACT WELLNESS CENTER LLC
NPI 1093579054
Clinic/Center - Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) in Lakeside, AZ

Active since February 09, 2024
3179 W WHITE MOUNTAIN BLVD, LAKESIDE, AZ 85929(615) 720-8088 Get Directions Write a Review

NPPES record last updated: May 1, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 1, 2024, Feb 9, 2024 (2 updates tracked since 2024).

About Impact Wellness Center Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IMPACT WELLNESS CENTER LLC (NPI 1093579054) is a healthcare organization registered as a rehabilitation, comprehensive outpatient rehabilitation facility (corf) in Lakeside, Arizona and active in the NPI registry since February 2024. The organization lists Charles Wade, Owner, as its authorized official.

NPPES Registry Identity

NPI1093579054
Entity TypeOrganization
Primary Taxonomy261QR0401X
Legal Business NameIMPACT WELLNESS CENTER LLC
Location Address3179 W WHITE MOUNTAIN BLVDLakeside, AZ 85929-6146
Mailing Address3179 W White Mountain BlvdLakeside, AZ 85929-6146 · (615) 720-8088
Phone(615) 720-8088
Organization SubpartNo
Authorized OfficialCharles WadeOwner · (615) 720-8088
Enumeration DateFebruary 9, 2024
Last NPPES UpdateMay 1, 20242 updates tracked since enumeration
NPPES CertifiedMay 1, 2024
✔ NPI 1093579054 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Ambulatory Health Care Facilities
Taxonomy Code261QR0401X
3179 W WHITE MOUNTAIN BLVD, Lakeside, AZ 85929
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Impact Wellness Center LLC's NPI number?

The NPI number for Impact Wellness Center LLC is 1093579054. It was assigned to this organization in the NPPES registry on February 9, 2024.

Where is Impact Wellness Center LLC located?

Impact Wellness Center LLC is located at 3179 W White Mountain Blvd, Lakeside, AZ 85929. The listed phone number is (615) 720-8088.

What is Impact Wellness Center LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF), with taxonomy code 261QR0401X.

When was this NPI record last updated?

The NPPES record for Impact Wellness Center LLC was last updated on May 1, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.