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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