Provider Demographics
NPI:1770948176
Name:IMIAH LLC
Entity type:Organization
Organization Name:IMIAH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAPRINA
Authorized Official - Middle Name:DOVELL
Authorized Official - Last Name:WINB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-236-4913
Mailing Address - Street 1:1855 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75134-4148
Mailing Address - Country:US
Mailing Address - Phone:469-236-4913
Mailing Address - Fax:972-224-0088
Practice Address - Street 1:7520 MARIETTA LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-4422
Practice Address - Country:US
Practice Address - Phone:469-236-4913
Practice Address - Fax:972-224-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility