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General NPI Number Information
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NPI Number | 1518333590
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Entity Type | Organization
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Legal Business Name | IMAGINE YOU, INC
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Dates
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Enumeration Date | 08/13/2015
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Last Update Date | 05/05/2021
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Provider Practice Location Address
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Address Line | 3313 N SONORA AVE
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City | FRESNO
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State | CA
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Zip | 93722-4668
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Country | US
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Telephone | 559-271-2708
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Fax | 559-412-5976
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Provider Business Mailing Address
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Address Line | PO BOX 5943
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City | FRESNO
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State | CA
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Zip | 93755-5943
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Country | US
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Telephone | 559-549-6610
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Fax | 559-412-2697
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Authorized Official
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Title or Position | DIRECTOR
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Name | DOROTHY SHANKLIN
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Credential |
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Telephone | 559-549-6610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 107203239
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 107203239
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 107203239
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | 107203239
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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