<Unavail>
LBN: Imani Community Out Reach Center
<Unavail> is an health care organization with primary practice located at 308 N Jackson St , Kosciusko MS 39090-3322. The organization recently has 3 registered licenses in different health care specialties including Other Service Providers / Community Health Worker, Ambulatory Health Care Facilities / Adult Day Care, Ambulatory Health Care Facilities / Multi-Specialty. Other Service Providers / Community Health Worker is the primary health care specialty.
Imani Community Out Reach Center can be contacted via phone (662) 289-7676, or through Ndiaye, Allie Glee via phone (662) 289-7676.
Contact Information
Primary practice address
308 N Jackson St
Kosciusko MS 39090-3322
Phone: (662) 289-7676
Fax: (662) 289-7688
Website:
Authorized official contact:
Name: Ndiaye, Allie Glee Licensed Practical Nurse (LPN)
Phone: (662) 289-7676
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Community Health Worker | 172V00000X | ||
| Ambulatory Health Care Facilities / Adult Day Care | 261QA0600X | ||
| Ambulatory Health Care Facilities / Multi-Specialty | 261QM1300X |
Profile Details
| NPI number | 1275977357 |
|---|---|
| LBN Legal business name | Imani Community Out Reach Center |
| DBA Doing business as | <Unavail> |
| Authorized official | Ndiaye, Allie Glee Licensed Practical Nurse (LPN) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Apr 19th, 2013 |
| Last updated | Mar 13th, 2014 - about 12 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1275977357 | NPPES |
| Mississippi | Other | 261QA0600X | 1172V00000X |
| Mississippi | MEDICAID | 261QA0600X | 1172V00000X |
| Mississippi | MEDICAID | 26QA0600X | 1172V00000X |
| Mississippi | MEDICAID | 261QM1300X | 1172V00000X |
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