Provider Demographics
NPI:1699169706
Name:IMPERIAL MANAGED CARE HCS INC
Entity type:Organization
Organization Name:IMPERIAL MANAGED CARE HCS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:LASHAY
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-537-9063
Mailing Address - Street 1:10815 SAGECANYON DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-3723
Mailing Address - Country:US
Mailing Address - Phone:832-537-9063
Mailing Address - Fax:
Practice Address - Street 1:10815 SAGECANYON DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-3723
Practice Address - Country:US
Practice Address - Phone:832-537-9063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXHMLMedicaid
TXHCSMedicaid