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General NPI Number Information
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NPI Number | 1144554791
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Entity Type | Organization
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Legal Business Name | IMANI HOSPITALITY HOMECARE
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Dates
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Enumeration Date | 09/30/2009
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Last Update Date | 09/30/2009
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Provider Practice Location Address
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Address Line | 501 DALE ST N
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City | SAINT PAUL
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State | MN
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Zip | 55103-1914
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Country | US
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Telephone | 651-917-9015
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Fax | 651-645-9937
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Provider Business Mailing Address
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Address Line | 501 DALE ST N
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City | SAINT PAUL
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State | MN
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Zip | 55103-1914
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Country | US
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Telephone | 651-917-9015
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Fax | 651-645-9937
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Authorized Official
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Title or Position | OWNER/ADMINSTRATOR
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Name | MRS. DONTRELL VALERIE THORNTON
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Credential |
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Telephone | 651-917-9015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | A280407700
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License Number State | MN
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