# IMANI COMMUNITY OUTREACH CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912273624
- **Authorized official:** TRICIA DUNCAN (BILLER)
- **Authorized official phone:** (601) 878-6945

## Contact information

- **Practice address:** 301 E JEFFERSON ST, KOSCIUSKO, MS 39090-3719
- **Practice address phone:** (662) 289-7676
- **Mailing address:** 301 E JEFFERSON ST, KOSCIUSKO, MS 39090-3719
- **Mailing address phone:** (662) 289-7676

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | MS | Yes |

## Other

- **Enumeration date:** 03/27/2012
- **Last updated:** 03/27/2012