Organization
IMAGINATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MONICA BOLTON (CHIEF ADMINISTRATIVE OFFICER)
(804) 402-1356
Entity
Organization
Contact information
Practice address
318 N WILKINSON RD, RICHMOND, VA 23227-1631
(804) 716-0593
(804) 330-6698
Mailing address
PO BOX 28586, HENRICO, VA 23228-8586
(804) 716-0593
(804) 330-6698
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
3189-14-008
VA
Other
Enumeration date
03/31/2018
Last updated
03/31/2018
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