Imani Community Outreach Center

NPI 1154765808 - Custodial Care Facility - 311ZA0620X

NPI Details
NPI 1154765808
Enumeration Date 04/24/2013
Last Updated 04/24/2013
Entity Type Healthcare Provider
Active Over 3 years ago
Authorized Information
Name ALLIE GLEE ALLIE
Position CEO
Phone (662) 289-7676
Fax
Practice Location
301 E JEFFERSON ST
KOSCIUSKO MS, 39090, US
Phone (662) 289-7676
Fax
Business Location
301 E JEFFERSON ST
KOSCIUSKO MS, 39090-3719, US
Phone (662) 289-7676
Fax
Toxanomy
Taxonomy Code 311ZA0620X
License State Mississippi
License Number 45383910
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According to our database, Imani Community Outreach Center NPI is 1154765808, taxonomy code is 311ZA0620X and license number is 45383910, license state is located at Mississippi. Imani Community Outreach Center physically located at 301 E Jefferson St, Kosciusko MS, 39090. NPI Number 1033115704 has the healthcare provider type.

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1154765808 NPI number is provided on an as is basis without warranty of any kind. 1154765808 is maintained by the National Plan & Provider Enumeration System. The contents of Imani Community Outreach Center are for informational purposes only.