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General NPI Number Information
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NPI Number | 1164232310
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Entity Type | Organization
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Legal Business Name | THE IMAGINATION STATION LLC
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 3286 W HILLSBORO ST STE A
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City | EL DORADO
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State | AR
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Zip | 71730-6734
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Country | US
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Telephone | 870-818-7190
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Fax |
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Provider Business Mailing Address
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Address Line | 230 TIDWELL ST
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City | STEPHENS
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State | AR
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Zip | 71764-8354
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Country | US
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Telephone | 870-818-7190
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MICHELLE GREEN
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Credential |
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Telephone | 870-818-7190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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