Provider Demographics
NPI:1679635569
Name:REIMAGINE NETWORK
Entity Type:Organization
Organization Name:REIMAGINE NETWORK
Other - Org Name:REIMAGINE NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF PROGRAMS & SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:CELESTINA
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:714-680-6060
Mailing Address - Street 1:1601 E SAINT ANDREW PL
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4940
Mailing Address - Country:US
Mailing Address - Phone:714-633-7400
Mailing Address - Fax:714-633-0738
Practice Address - Street 1:1601 E SAINT ANDREW PL
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4940
Practice Address - Country:US
Practice Address - Phone:714-633-7400
Practice Address - Fax:714-633-0738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAI24111L261Q00000X
261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056503Medicare ID - Type Unspecified