Provider Demographics
NPI:1740885417
Name:REIMAGINE NETWORK
Entity type:Organization
Organization Name:REIMAGINE NETWORK
Other - Org Name:
Other - Org Type:
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:714-633-7400
Mailing Address - Street 1:1601 E SAINT ANDREW PL
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4940
Mailing Address - Country:US
Mailing Address - Phone:714-633-7400
Mailing Address - Fax:
Practice Address - Street 1:1601 E SAINT ANDREW PL
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4940
Practice Address - Country:US
Practice Address - Phone:714-633-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)