Provider Demographics
NPI:1235534991
Name:IMAGINE ART
Entity Type:Organization
Organization Name:IMAGINE ART
Other - Org Name:IMAGINE ART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KIZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-554-2406
Mailing Address - Street 1:2830 REAL ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78722-1715
Mailing Address - Country:US
Mailing Address - Phone:512-554-2406
Mailing Address - Fax:512-524-4948
Practice Address - Street 1:2830 REAL ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78722-1715
Practice Address - Country:US
Practice Address - Phone:512-554-2406
Practice Address - Fax:512-524-4948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services