Provider Demographics
NPI:1285005710
Name:IMAGINE ENTERPRISES INC.
Entity Type:Organization
Organization Name:IMAGINE ENTERPRISES INC.
Other - Org Name:OJAS WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:H
Authorized Official - Last Name:BRANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-845-3379
Mailing Address - Street 1:10 FILA WAY
Mailing Address - Street 2:STE 201-A
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9452
Mailing Address - Country:US
Mailing Address - Phone:443-845-3379
Mailing Address - Fax:443-212-5766
Practice Address - Street 1:6020 MEADOWRIDGE CENTER DR
Practice Address - Street 2:UNIT E
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6528
Practice Address - Country:US
Practice Address - Phone:443-845-3379
Practice Address - Fax:443-212-5766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01832171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty