Provider Demographics
NPI:1558833475
Name:IMAGINE NURTURING OUR WARRIORS, LTD
Entity type:Organization
Organization Name:IMAGINE NURTURING OUR WARRIORS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MEUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-237-5403
Mailing Address - Street 1:7808 W BOULEVARD DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22308-1001
Mailing Address - Country:US
Mailing Address - Phone:571-237-5403
Mailing Address - Fax:
Practice Address - Street 1:2500 PERLITER AVE
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7309
Practice Address - Country:US
Practice Address - Phone:571-237-5403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health