MEDICARE: IMANI TRANSPORTATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1841959061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMANI TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	3585 GROVE ST UNIT 149
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-1843
Country	:	US
Telephone Number	:	619-908-0207
Fax Number	:

Provider Business Practice Location Address
First Line	:	3585 GROVE ST UNIT 149
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-1843
Country	:	US
Telephone Number	:	619-908-0207
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ABDIMAJID IMAN
Credential	:
Telephone Number	:	619-908-0207

Provider Enumeration Date	:	12/15/2021
Last Update Date	:	12/15/2021

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Directions to “IMANI TRANSPORTATION LLC ” Practice Location

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