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General NPI Number Information
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NPI Number | 1538833207
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Entity Type | Organization
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Legal Business Name | IMANI HEALTH SYSTEMS INCORPORATED
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Dates
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Enumeration Date | 08/05/2021
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 158 FAIRVIEW RD STE B3
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City | ELLENWOOD
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State | GA
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Zip | 30294-2795
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Country | US
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Telephone | 678-571-2928
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Fax |
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Provider Business Mailing Address
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Address Line | 158 FAIRVIEW RD STE B3
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City | ELLENWOOD
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State | GA
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Zip | 30294-2795
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Country | US
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Telephone | 678-571-2928
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | KHADIJAH CHAPPELL
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Credential | MBA
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Telephone | 678-571-2928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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