Provider Demographics
NPI:1518333590
Name:IMAGINE YOU, INC
Entity Type:Organization
Organization Name:IMAGINE YOU, INC
Other - Org Name:IMAGINE YOU, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-549-6610
Mailing Address - Street 1:PO BOX 5943
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93755-5943
Mailing Address - Country:US
Mailing Address - Phone:559-549-6610
Mailing Address - Fax:559-412-2697
Practice Address - Street 1:3313 N SONORA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-4668
Practice Address - Country:US
Practice Address - Phone:559-271-2708
Practice Address - Fax:559-412-5976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-13
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107203239251V00000X, 320800000X, 322D00000X, 3245S0500X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251V00000XAgenciesVoluntary or Charitable
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children