Provider Demographics
NPI:1538833207
Name:IMANI HEALTH SYSTEMS INCORPORATED
Entity type:Organization
Organization Name:IMANI HEALTH SYSTEMS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KHADIJAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:678-571-2928
Mailing Address - Street 1:158 FAIRVIEW RD STE B3
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-2795
Mailing Address - Country:US
Mailing Address - Phone:678-571-2928
Mailing Address - Fax:
Practice Address - Street 1:158 FAIRVIEW RD STE B3
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-2795
Practice Address - Country:US
Practice Address - Phone:678-571-2928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health