Provider Demographics
NPI:1336433804
Name:I.M.A.G.E TRANSITIONAL HOMES, INC.
Entity Type:Organization
Organization Name:I.M.A.G.E TRANSITIONAL HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-541-1370
Mailing Address - Street 1:545 PINEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95838-1517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8575 ELK GROVE FLORIN RD
Practice Address - Street 2:APT. 330
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-9532
Practice Address - Country:US
Practice Address - Phone:916-833-9558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42444302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization