Provider Demographics
NPI:1457920803
Name:IMAGINE ENTERPRISES
Entity Type:Organization
Organization Name:IMAGINE ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NORINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-439-9057
Mailing Address - Street 1:1402 SPRING CRESS LN
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-4719
Mailing Address - Country:US
Mailing Address - Phone:832-439-9057
Mailing Address - Fax:866-672-6062
Practice Address - Street 1:1402 SPRING CRESS LN
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586-4719
Practice Address - Country:US
Practice Address - Phone:832-439-9057
Practice Address - Fax:866-672-6062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-21
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001010736OtherTX HHSC CONTRACT FMSA
TX001010739OtherTX HHSC CONTRACT FMSA
TX001010740OtherTX HHSC CONTRACT FMSA
TXHHS000003700005OtherTX HHSC CONTRACT FMSA
TX001007318OtherTX HHSC CONTRACT FMSA
TX001010738OtherTX HHSC CONTRACT FMSA
TXHHS000003900001OtherTX HHSC CONTRACTS FOR FMSA
TX001008315OtherTX HHSC CONTRACT FMSA
TX001008317OtherTX HHSC CONTRACT FMSA
TX001008316OtherTX HHSC CONTRACT FMSA
TX001008319OtherTX HHSC CONTRACT FMSA
TX001008314OtherTX HHSC CONTRACT FMSA
TX001010735OtherTX HHSC CONTRACT FMSA
TX001010737OtherTX HHSC CONTRACT FMSA