Provider Demographics
NPI:1962707588
Name:IMAGE HOUSE, INC
Entity type:Organization
Organization Name:IMAGE HOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-385-6100
Mailing Address - Street 1:3542 SPRINGDALE RD.
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-1331
Mailing Address - Country:US
Mailing Address - Phone:513-385-6100
Mailing Address - Fax:513-245-6482
Practice Address - Street 1:3542 SPRINGDALE RD.
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-1331
Practice Address - Country:US
Practice Address - Phone:513-385-6100
Practice Address - Fax:513-245-6482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies