IMANI COMMUNITY OUTREACH CENTER (NPI# 1154765808) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154765808 |
| Entity Type | Organization |
| Organization Name | IMANI COMMUNITY OUTREACH CENTER |
| Other Organization Name | IMANI COMMUNITY OUTREACH CENTER |
| Practice Address |
301 E Jefferson St Kosciusko MS 39090 |
| Mailing Address |
301 E Jefferson St Kosciusko MS 39090-3719 |
| Practice Telephone | 6622897676 |
| Mailing Telephone | 6622897676 |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2013-04-24 |
| Authorized Official Name | MRS. ALLIE GLEE NDIAYE I (CEO) |
| Authorized Official Telephone | 6622897676 |
| Authorized Official Credential | LPN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
45383910 | MS | Nursing & Custodial Care Facilities |
| N | 385H00000X | Respite Care | ========= | MS | Respite Care Facility |
| Y | 347C00000X | Private Vehicle | ========= | MS | Transportation Services |
| Other Name | Type Code |
|---|---|
| Imani Community OutReach Center | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467726000 | Imani Community Outreach Center | Nursing Care | 308 N Jackson Street, Kosciusko, MS 39090-1453 | 2012-02-29 |
| 1457623118 | Imani Community Outreach Center | Respite Care | 207 Poplar St, Kosciusko, MS 39090-4409 | 2012-01-27 |
| 1912273624 | Imani Community Outreach Center | Physical Therapist | 301 E Jefferson St, Kosciusko, MS 39090-3719 | 2012-03-27 |
| 1477829182 | Imani Community Outreach Center | Occupational Therapist | 301 E Jefferson St, Kosciusko, MS 39090-3719 | 2012-03-27 |
| 1467728360 | Imani Community Outreach Center | Social Worker | 301 E Jefferson St, Kosciusko, MS 39090-3719 | 2012-03-26 |
| 1245502962 | Imani Community Outreach Center | Homemaker | 301 E Jefferson St, Kosciusko, MS 39090-3719 | 2012-01-27 |
| Street Address |
301 E JEFFERSON ST |
| City | KOSCIUSKO |
| State | MS |
| Zip Code | 39090 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295174555 | Imani Community Out Reach Center | Preferred Provider Organization | 301 E Jefferson St, Kosciusko, MS 39090-3719 | 2013-06-20 |
| 1912264250 | Imani Community Outreach Ctr Inc | Home Health | 301 E Jefferson St, Kosciusko, MS 39090-3719 | 2012-04-11 |
| 1912273624 | Imani Community Outreach Center | Physical Therapist | 301 E Jefferson St, Kosciusko, MS 39090-3719 | 2012-03-27 |
| 1477829182 | Imani Community Outreach Center | Occupational Therapist | 301 E Jefferson St, Kosciusko, MS 39090-3719 | 2012-03-27 |
| 1467728360 | Imani Community Outreach Center | Social Worker | 301 E Jefferson St, Kosciusko, MS 39090-3719 | 2012-03-26 |
| 1245502962 | Imani Community Outreach Center | Homemaker | 301 E Jefferson St, Kosciusko, MS 39090-3719 | 2012-01-27 |
| 1669749081 | Imani Community Outreach Ctr | Driver | 301 E Jefferson St, Kosciusko, MS 39090-3719 | 2011-11-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508371675 | Caroline Boydstun Fair | Pharmacist | 109 Northside Center, Kosciusko, MS 39090 | 2017-12-11 |
| 1275069643 | Sharhonda Wingo | Speech-Language Pathologist | 2447 Attala Road 2203, Kosciusko, MS 39090 | 2017-05-04 |
| 1013392034 | Leap of Faith LLC | Respite Care | 115 North Wells Street, Suite A, Kosciusko, MS 39090 | 2015-07-21 |
| 1730566027 | Bmc - Attala, LLC | General Acute Care Hospital | 220 Hwy. 12 West, Kosciusko, MS 39090 | 2015-05-06 |
| 1528402484 | Warner Martin Myers I | Student in an Organized Health Care Education/Training Program | 912 Hwy 12 East, Kosciusko, MS 39090 | 2013-04-23 |
| 1891022547 | Medical Foundation of Central Mississippi | Internal Medicine | 329 Highway 12 West, Koscuisko, MS 39090 | 2009-11-17 |
| 1255512448 | Cheryl L Bayne | Adult Companion | 509 Hillview Dr, Kosciusko, MS 39090 | 2007-11-16 |
| 1760673982 | Gary A Cochran | Technician/Technologist | 118 West North St, Kosciusko, MS 39090 | 2007-08-05 |
| 1639396393 | Stephen C Hammack | Family Medicine | 332 Highway 12 West, Kosciusko, MS 39090 | 2007-04-20 |
| 1740329689 | Brenda Nail | Nurse Practitioner | 999 Martin Luther King Drive, Kosciusko, MS 39090 | 2007-02-06 |
| Find all providers in zip 39090 | ||||
| Taxonomy Code | 347C00000X |
| Grouping | Transportation Services |
| Classification | Private Vehicle |
| An individual paid to provide non-emergency transportation using their privately owned/leased vehicle. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639665045 | Heartfelt Personal Care | Private Vehicle | 207 N Huntington St Bldg C, Kosciusko, MS 39090-3351 | 2018-07-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437759388 | Sarah Walls | Private Vehicle | 3765 Hilltop Dr, Horn Lake, MS 38637-1030 | 2020-10-29 |
| 1164055489 | R&p Elite Services, LLC | Private Vehicle | 68 Springfield Rd., Petal, MS 39465 | 2020-02-14 |
| 1902459126 | Steven Cunningham | Private Vehicle | 704 Hawthorn Green Dr, Ridgeland, MS 39157-1542 | 2019-07-17 |
| 1891355509 | Hidden Oaks Transportation LLC | Private Vehicle | 172 North Boose Street, Hickory, MS 39332 | 2019-06-14 |
| 1174086318 | Jermaine Mcneal | Private Vehicle | 1056 Autumn St, Jackson, MS 39212-2554 | 2019-04-12 |
| 1912464363 | Aleighsha Chante Prince | Private Vehicle | 402 High St, Kilmichael, MS 39747-9659 | 2019-02-21 |
| 1013487198 | Jason Riley | Private Vehicle | 28a James Smith Rd, Tylertown, MS 39667-7930 | 2018-11-30 |
| 1396210274 | Hooper Transportation LLC | Private Vehicle | 105 Jacinto Heights, No 2, Booneville, MS 38829 | 2018-10-08 |
| 1750866612 | Aduba Hervey | Private Vehicle | 1731 Anderson Rd Apt 48, Oxford, MS 38655-2548 | 2018-09-26 |
| 1598249112 | Amber Eiland Bell | Private Vehicle | 8596 Kinard Cv, Southaven, MS 38671-2900 | 2018-09-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.