Provider Demographics
NPI:1790065365
Name:IMAGE HOUSE
Entity Type:Organization
Organization Name:IMAGE HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMSEY
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:757-610-0600
Mailing Address - Street 1:1408 SPRING RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-3116
Mailing Address - Country:US
Mailing Address - Phone:757-610-0600
Mailing Address - Fax:757-966-9186
Practice Address - Street 1:1408 SPRING RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-3116
Practice Address - Country:US
Practice Address - Phone:757-610-0600
Practice Address - Fax:757-966-9186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1612320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities