Provider Demographics
NPI:1255480646
Name:IMAGINATIVE HORIZONS INC
Entity Type:Organization
Organization Name:IMAGINATIVE HORIZONS INC
Other - Org Name:HILLCREST MANOR SANITARIUM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-477-1176
Mailing Address - Street 1:1889 NATIONAL CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1889 NATIONAL CITY BLVD
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-0000
Practice Address - Country:US
Practice Address - Phone:619-477-1176
Practice Address - Fax:619-477-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05975GMedicaid
CA055975Medicare Oscar/Certification