# VIVID IMAGINATION STATION LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033954227
- **Authorized official:** IRENA BILOUS (SPECIAL EDUCATION)
- **Authorized official phone:** (718) 730-4442

## Contact information

- **Practice address:** 216 JUSTIN AVE, STATEN ISLAND, NY 10306-3744
- **Practice address phone:** (718) 730-4442
- **Mailing address:** 216 JUSTIN AVE, STATEN ISLAND, NY 10306-3744
- **Mailing address phone:** (718) 730-4442

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 06/28/2024
- **Last updated:** 07/01/2024