Provider Demographics
NPI:1205666542
Name:IMPACT DAYTON
Entity type:Organization
Organization Name:IMPACT DAYTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KANIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-620-3918
Mailing Address - Street 1:5325 WOOD DALE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-3838
Mailing Address - Country:US
Mailing Address - Phone:937-620-7090
Mailing Address - Fax:
Practice Address - Street 1:5325 WOOD DALE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-3838
Practice Address - Country:US
Practice Address - Phone:937-620-7090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services