Healthcare Provider Details

I. General information

NPI: 1336433804
Provider Name (Legal Business Name): I.M.A.G.E TRANSITIONAL HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8575 ELK GROVE FLORIN RD APT. 330
ELK GROVE CA
95624-9532
US

IV. Provider business mailing address

545 PINEDALE AVE
SACRAMENTO CA
95838-1517
US

V. Phone/Fax

Practice location:
  • Phone: 916-833-9558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberMFC42444
License Number StateCA

VIII. Authorized Official

Name: MARY HORTON
Title or Position: PRESIDENT
Credential:
Phone: 916-541-1370