# IMAGINE SUPPORTED LIVING SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Imagine Supported Living
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356533244
- **Authorized official:** DOUGLAS PASCOVER (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (831) 464-8355

## Contact information

- **Practice address:** 9065 SOQUEL DR, APTOS, CA 95003-4001
- **Practice address phone:** (831) 464-8355
- **Practice address fax:** (831) 464-8658
- **Mailing address:** 9065 SOQUEL DR, APTOS, CA 95003-4001
- **Mailing address phone:** (831) 464-8355

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 08/14/2007
- **Last updated:** 01/18/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | HCB00012F | — | CA |