Provider Demographics
NPI:1396576120
Name:IMAGINE GREATER HOMECARE LLC
Entity type:Organization
Organization Name:IMAGINE GREATER HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-413-4513
Mailing Address - Street 1:305 MAPLE HILL CIR
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-3931
Mailing Address - Country:US
Mailing Address - Phone:731-413-4513
Mailing Address - Fax:
Practice Address - Street 1:305 MAPLE HILL CIR
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063-3931
Practice Address - Country:US
Practice Address - Phone:731-413-4513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care