MEDICARE: IMAGINATIVE HORIZONS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255480646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMAGINATIVE HORIZONS INC

Provider Business Mailing Address
First Line	:	1889 NATIONAL CITY BLVD
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-0000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1889 NATIONAL CITY BLVD
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-0000
Country	:	US
Telephone Number	:	619-477-1176
Fax Number	:	619-477-9933

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	GARY BYRNES
Credential	:
Telephone Number	:	619-477-1176

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	03/24/2008

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