Organization
IMAGINE SUPPORTED LIVING SERVICES
Active
Other names
Imagine Supported Living
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS PASCOVER (EXECUTIVE DIRECTOR)
(831) 464-8355
Entity
Organization
Contact information
Practice address
9065 SOQUEL DR, APTOS, CA 95003-4001
(831) 464-8355
(831) 464-8658
Mailing address
9065 SOQUEL DR, APTOS, CA 95003-4001
(831) 464-8355
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
HCB00012F
—
CA
Enumeration date
08/14/2007
Last updated
01/18/2021
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