Organization
IMANI COMMUNITY OUTREACH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRICIA B DUNCAN (BILLER)
(601) 878-6945
Entity
Organization
Contact information
Practice address
207 POPLAR ST, KOSCIUSKO, MS 39090-4409
(662) 739-3399
Mailing address
207 POPLAR ST, KOSCIUSKO, MS 39090-4409
(662) 739-3399
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00500750
—
MS
Enumeration date
01/27/2012
Last updated
01/27/2012
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