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  7. NPI Record 1235609546

IMPACT A.B.A. THERAPY, INC.
Complete NPI Record 1235609546
Behavior Analyst in Rocky Mount, NC

NPI Status: Active since November 29, 2018

Contact Information

3661 SUNSET AVE STE 353
ROCKY MOUNT, NC
ZIP 27804
Phone: (919) 763-4653

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider First Line Business Practice Location Address
  11. Provider Business Practice Location Address City Name
  12. Provider Business Practice Location Address State Name
  13. Provider Business Practice Location Address Postal Code
  14. Provider Business Practice Location Address Country Code If outside U S
  15. Provider Business Practice Location Address Telephone Number
  16. Provider Enumeration Date
  17. Last Update Date
  18. Authorized Official Last Name
  19. Authorized Official First Name
  20. Authorized Official Middle Name
  21. Authorized Official Title or Position
  22. Authorized Official Telephone Number
  23. Healthcare Provider Taxonomy Code 1
  24. Healthcare Provider Primary Taxonomy Switch 1
  25. Healthcare Provider Taxonomy Code 2
  26. Healthcare Provider Primary Taxonomy Switch 2
  27. Is Organization Subpart
  28. Authorized Official Credential Text
  29. Healthcare Provider Taxonomy Group 2

Complete NPI Dataset

This page represents the complete record for NPI 1235609546. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1235609546
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider First Line Business Mailing Address: 3661 SUNSET AVE STE 353
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: ROCKY MOUNT
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address State Name: NC
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 278043411
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider First Line Business Practice Location Address: 3661 SUNSET AVE STE 353
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Practice Location Address City Name: ROCKY MOUNT
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: NC
The city name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code: 278043411
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number: 9197634653
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 11/29/2018
The telephone number associated with the location address of the provider being identified.
Last Update Date: 11/29/2018
The date that a record was last updated or changed.
Authorized Official Last Name: BARNES
The date that a record was last updated or changed.
Authorized Official First Name: TEPHANIE
The first name of the authorized official.
Authorized Official Middle Name: SHANELLE
The middle name of the authorized official.
Authorized Official Title or Position: OWNER
The title or position of the authorized official.
Authorized Official Telephone Number: 9197634653
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 251S00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 103K00000X
Healthcare Provider Primary Taxonomy Switch 2: Y
Is Organization Subpart: N
Authorized Official Credential Text: M.S., BCBA ,LBA
Healthcare Provider Taxonomy Group 2: 193400000X SINGLE SPECIALTY GROUP