Provider Demographics
NPI:1750503298
Name:IMADULATION INTERNATIONAL, LP
Entity Type:Organization
Organization Name:IMADULATION INTERNATIONAL, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:CHERNOFF
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:972-880-0102
Mailing Address - Street 1:7201 CUTTER MILL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248
Mailing Address - Country:US
Mailing Address - Phone:972-880-0102
Mailing Address - Fax:
Practice Address - Street 1:2007 N COLLINS BLVD
Practice Address - Street 2:#509A
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2658
Practice Address - Country:US
Practice Address - Phone:972-880-0102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies