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Organization
IMANI COMMUNITY OUTREACH CENTER
Active
Organization
IMANI COMMUNITY OUTREACH CENTER
Active
Other names
Imani Community OutReach Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALLIE GLEE NDIAYE I LPN (CEO)
(662) 289-7676
Entity
Organization
Contact information
Practice address
301 E JEFFERSON ST, KOSCIUSKO, MS 39090
(662) 289-7676
Mailing address
301 E JEFFERSON ST, KOSCIUSKO, MS 39090-3719
(662) 289-7676
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
45383910
MS
347C00000X
Private Vehicle
Primary
—
MS
385H00000X
Respite Care
—
MS
Other
Enumeration date
04/24/2013
Last updated
07/21/2022
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