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General NPI Number Information
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NPI Number | 1326402090
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Entity Type | Organization
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Legal Business Name | REIMAGE COLLECTIVE LLC
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Dates
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Enumeration Date | 04/08/2016
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Last Update Date | 04/15/2020
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Provider Practice Location Address
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Address Line | 432 S SAGINAW ST STE 300
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City | FLINT
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State | MI
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Zip | 48502-1845
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Country | US
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Telephone | 810-553-6013
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Fax | 844-713-3792
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Provider Business Mailing Address
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Address Line | 432 S SAGINAW ST STE 300
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City | FLINT
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State | MI
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Zip | 48502-1845
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Country | US
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Telephone | 810-553-6013
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | GEORGE CONWAY
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Credential |
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Telephone | 810-513-8399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801097477
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License Number State | MI
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