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Organization
IMANI COMMUNITY OUT REACH CENTER
Active
Organization
IMANI COMMUNITY OUT REACH CENTER
Active
Other names
Garden Angles
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ALLIE G NDIAYE I (CEO)
(662) 289-7676
Entity
Organization
Contact information
Practice address
301 E JEFFERSON ST, KOSCIUSKO, MS 39090-3719
(662) 289-7676
Mailing address
301 E JEFFERSON ST, KOSCIUSKO, MS 39090-3719
(662) 289-7676
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
7862
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08533763
HOSPICE
MS
01
—
172V00000X
CLINIC SOCIAL WORKER
MS
01
—
261QA0600X
ADULT DAY CARE
—
Enumeration date
06/20/2013
Last updated
06/20/2013
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