Organization
IMANI COMMUNITY OUTREACH CTR INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRICIA DUNCAN (BILLER)
(601) 878-6945
Entity
Organization
Contact information
Practice address
301 E JEFFERSON ST, KOSCIUSKO, MS 39090-3719
(662) 289-7676
(662) 289-7678
Mailing address
301 E JEFFERSON ST, KOSCIUSKO, MS 39090-3719
(662) 289-7676
(662) 289-7678
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00500750
—
MS
05
—
00686258
—
MS
05
—
09950749
—
MS
Enumeration date
04/11/2012
Last updated
04/11/2012
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