Provider Demographics
NPI:1538207535
Name:HANNA & IMTIAZ INC,.
Entity type:Organization
Organization Name:HANNA & IMTIAZ INC,.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IMTIAZ
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:CROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:386-437-9928
Mailing Address - Street 1:103 RAEMOOR DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6803
Mailing Address - Country:US
Mailing Address - Phone:386-437-9928
Mailing Address - Fax:386-437-9928
Practice Address - Street 1:103 RAEMOOR DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-6803
Practice Address - Country:US
Practice Address - Phone:386-437-9928
Practice Address - Fax:386-437-9928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0412069320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities