Provider Demographics
NPI:1124747043
Name:IMAGE HOMECARE LLC
Entity type:Organization
Organization Name:IMAGE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHADGA
Authorized Official - Middle Name:THULUNG
Authorized Official - Last Name:RAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-468-5743
Mailing Address - Street 1:122 PARKER LN
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2523
Mailing Address - Country:US
Mailing Address - Phone:570-468-5743
Mailing Address - Fax:
Practice Address - Street 1:122 PARKER LN
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2523
Practice Address - Country:US
Practice Address - Phone:570-468-5743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care