Provider Demographics
NPI:1871660126
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:SENIOR DIRECTOR - CLINICAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:ERLENBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:949-498-7671
Mailing Address - Street 1:2021 CALLE FRONTERA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-5645
Mailing Address - Country:US
Mailing Address - Phone:949-498-7671
Mailing Address - Fax:949-361-3361
Practice Address - Street 1:2021 CALLE FRONTERA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-5645
Practice Address - Country:US
Practice Address - Phone:949-498-7671
Practice Address - Fax:949-361-3361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000022261QA0600X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service