Provider Demographics
NPI:1326402090
Name:REIMAGE COLLECTIVE LLC
Entity Type:Organization
Organization Name:REIMAGE COLLECTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-513-8399
Mailing Address - Street 1:432 S SAGINAW ST STE 300
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-1845
Mailing Address - Country:US
Mailing Address - Phone:810-553-6013
Mailing Address - Fax:
Practice Address - Street 1:432 S SAGINAW ST STE 300
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-1845
Practice Address - Country:US
Practice Address - Phone:810-553-6013
Practice Address - Fax:844-713-3792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801097477104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty