Provider Demographics
NPI:1144554791
Name:IMANI HOSPITALITY HOMECARE
Entity type:Organization
Organization Name:IMANI HOSPITALITY HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONTRELL
Authorized Official - Middle Name:VALERIE
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-917-9015
Mailing Address - Street 1:501 DALE ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-1914
Mailing Address - Country:US
Mailing Address - Phone:651-917-9015
Mailing Address - Fax:651-645-9937
Practice Address - Street 1:501 DALE ST N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-1914
Practice Address - Country:US
Practice Address - Phone:651-917-9015
Practice Address - Fax:651-645-9937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA280407700253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA280407700OtherPERSONAL CARE PROVIDER ORGANIZATION