Organization
IMANI COMMUNITY OUT REACH CENTER
Active
Other names
Imami Community Center
Organization subpart
No
Provider details
NPI number
Authorized official
MISS ALLIE GLEE NDIAYE LPN (CEO)
(662) 289-7676
Entity
Organization
Contact information
Practice address
308 N JACKSON ST, KOSCIUSKO, MS 39090-3322
(662) 289-7676
(662) 289-7688
Mailing address
308 N JACKSON ST, KOSCIUSKO, MS 39090-3322
(662) 289-7676
(662) 289-7688
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
261QA0600X
1172V00000X
MS
05
—
261QA0600X
—
MS
05
—
261QM1300X
—
MS
05
—
26QA0600X
—
MS
Enumeration date
04/19/2013
Last updated
03/13/2014
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