Provider Demographics
NPI:1235511163
Name:CLINICA IMPERIAL, LLC
Entity Type:Organization
Organization Name:CLINICA IMPERIAL, LLC
Other - Org Name:CAREGISTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-833-2900
Mailing Address - Street 1:9453 AMBERDALE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-1249
Mailing Address - Country:US
Mailing Address - Phone:804-447-9540
Mailing Address - Fax:
Practice Address - Street 1:6413 HACKNEY CIR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-4573
Practice Address - Country:US
Practice Address - Phone:804-833-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-27
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251E00000XAgenciesHome Health