{"npi":"1093579054","type":"NPI-2","status":"active","name":{"display":"Impact Wellness Center LLC","other":[],"organization_name":"IMPACT WELLNESS CENTER LLC","authorised_official":"Charles Wade"},"specialty":{"primary_taxonomy":"261QR0401X","primary_taxonomy_description":"Comprehensive Outpatient Rehabilitation Facility (CORF)","slug":"comprehensive-outpatient-rehabilitation-facility-corf","schema_org_specialty":null,"all":[{"code":"261QR0401X","description":"Comprehensive Outpatient Rehabilitation Facility (CORF)","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"3179 W WHITE MOUNTAIN BLVD","city":"LAKESIDE","state":"AZ","postal_code":"859296146","country_code":"US","phone":"6157208088"},{"purpose":"MAILING","street_1":"3179 W WHITE MOUNTAIN BLVD","city":"LAKESIDE","state":"AZ","postal_code":"859296146","country_code":"US","phone":"6157208088"}],"license":null,"identifiers":[],"pecos":{"enrolled_at":null,"enrollments":[]},"enumeration_date":"2024-02-09","last_updated":"2024-05-01","_meta":{"source":"NPPES","snapshot_date":"2024-05-01","doc_url":"https://findmynpi.com/api"}}