Provider Demographics
NPI:1902104730
Name:IMANI FOUNDATION, INC.
Entity Type:Organization
Organization Name:IMANI FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER (CEO)
Authorized Official - Prefix:MS
Authorized Official - First Name:BERNADINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:404-584-6288
Mailing Address - Street 1:3201 ATLANTA INDUSTRIAL PKWY NW
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-1045
Mailing Address - Country:US
Mailing Address - Phone:404-584-6288
Mailing Address - Fax:404-584-6292
Practice Address - Street 1:3201 ATLANTA INDUSTRIAL PKWY NW
Practice Address - Street 2:SUITE 303
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-1045
Practice Address - Country:US
Practice Address - Phone:404-584-6288
Practice Address - Fax:404-584-6292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management