| Organization Name: | IMANI COMMUNITY OUT REACH CENTER |
| NPI Number: | 1275977357 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ALLIE GLEE NDIAYE (CEO) |
| Mailing Address: | 308 N Jackson St Kosciusko |
| State: | MS US |
| Postal Code: | 390903322 |
| Phone Number: | 6622897676 |
| Fax Number: | 6622897688 |
| NPI Enumeration Date: | 04/19/2013 |
| NPI Last Update Date: | 03/13/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA0600X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Adult Day Care |
| Taxonomy Definition: | |