IMANI COMMUNITY OUTREACH CENTER (NPI# 1457623118) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457623118 |
| Entity Type | Organization |
| Organization Name | IMANI COMMUNITY OUTREACH CENTER |
| Practice Address |
207 Poplar St Kosciusko MS 39090-4409 |
| Practice Telephone | 6627393399 |
| Mailing Telephone | 6627393399 |
| Enumeration Date | 2012-01-27 |
| Last Update Date | 2012-01-27 |
| Authorized Official Name | TRICIA B DUNCAN (BILLER) |
| Authorized Official Telephone | 6018786945 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 385H00000X | Respite Care | Respite Care Facility |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00500750 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467726000 | Imani Community Outreach Center | Nursing Care | 308 N Jackson Street, Kosciusko, MS 39090-1453 | 2012-02-29 |
| 1154765808 | Imani Community Outreach Center | Custodial Care Facility | 301 E Jefferson St, Kosciusko, MS 39090 | 2013-04-24 |
| 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 |
207 POPLAR ST |
| City | KOSCIUSKO |
| State | MS |
| Zip Code | 39090-4409 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740650969 | Imani Community Center | Preferred Provider Organization | 207 Poplar St, Kosciusko, MS 39339 | 2015-09-30 |
| 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 | 385H00000X |
| Grouping | Respite Care Facility |
| Classification | Respite Care |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013392034 | Leap of Faith LLC | Respite Care | 115 North Wells Street, Suite A, Kosciusko, MS 39090 | 2015-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467050237 | Unified Home & Respite Care, LLC | Respite Care | 317 Highland Blvd Ste G, Natchez, MS 39120-4634 | 2020-10-14 |
| 1124636659 | Graceful Serenity LLC | Respite Care | 1440 Dunn Pease Rd, Raymond, MS 39154-8252 | 2020-07-21 |
| 1194342592 | Tashanda Chamberlin | Respite Care | 100 Hopper Ave, Dekalb, MS 39328 | 2020-07-01 |
| 1801412838 | Ycsc Gulf Coast Ms, LLC | Respite Care | 770 Water St Ste 428, Biloxi, MS 39530-4220 | 2020-06-25 |
| 1215552005 | Demetress Brent | Respite Care | 2941 Sheila Dr, Jackson, MS 39209-6125 | 2020-06-08 |
| 1912531427 | Magnolia Personal Care LLC | Respite Care | 69 Bo Stampley Rd, Fayette, MS 39069-4879 | 2020-02-24 |
| 1750935714 | La Respite, LLC | Respite Care | 701 Bowie Ln, Greenwood, MS 38930-5935 | 2019-07-29 |
| 1851944524 | Tracey Bernard Scurlock Jr. | Respite Care | 3747 Eureka Rd, Batesville, MS 38606-8064 | 2019-07-22 |
| 1295394377 | Divinity Community Living, Inc. | Respite Care | 405 Briarwood Dr Ste 108q, Jackson, MS 39206-3032 | 2019-06-11 |
| 1871062521 | Live, Laugh and Love Homecare Services | Respite Care | 604 Highway 80 W Ste Roffice1, Clinton, MS 39056-4108 | 2018-11-23 |
| 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.