1457920803 NPI number — IMAGINE ENTERPRISES

Table of content: (NPI 1457920803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457920803 NPI number — IMAGINE ENTERPRISES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMAGINE ENTERPRISES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457920803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1402 SPRING CRESS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEABROOK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77586-4719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-439-9057
Provider Business Mailing Address Fax Number:
866-672-6062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1402 SPRING CRESS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEABROOK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77586-4719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-439-9057
Provider Business Practice Location Address Fax Number:
866-672-6062
Provider Enumeration Date:
06/21/2021

Additional Information

Authorized Official

Authorized Official Last Name:
GILL
Authorized Official First Name:
NORINE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
832-439-9057

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001010736 . This is a "TX HHSC CONTRACT FMSA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001010739 . This is a "TX HHSC CONTRACT FMSA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001010740 . This is a "TX HHSC CONTRACT FMSA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HHS000003700005 . This is a "TX HHSC CONTRACT FMSA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001007318 . This is a "TX HHSC CONTRACT FMSA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001010738 . This is a "TX HHSC CONTRACT FMSA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HHS000003900001 . This is a "TX HHSC CONTRACTS FOR FMSA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001008315 . This is a "TX HHSC CONTRACT FMSA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001008317 . This is a "TX HHSC CONTRACT FMSA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001008316 . This is a "TX HHSC CONTRACT FMSA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001008319 . This is a "TX HHSC CONTRACT FMSA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001008314 . This is a "TX HHSC CONTRACT FMSA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001010735 . This is a "TX HHSC CONTRACT FMSA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001010737 . This is a "TX HHSC CONTRACT FMSA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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