NPIMap

Organization Active NPI

Imani Community Out Reach Center

  • Community Health Worker
  • Kosciusko, MS
National Provider Identifier
1275977357
Registry record updated Mar 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health WorkerTaxonomy code 172V00000X
Legal business name
IMANI COMMUNITY OUT REACH CENTER
Practice address
308 N Jackson St
Kosciusko, MS 39090-3322
Phone
(662) 289-7676
Fax
(662) 289-7688
NPI assigned
Apr 19, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Miss Allie Glee Ndiaye, LPN
Title
Ceo
Phone
(662) 289-7676

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 172V00000X Primary
Adult Day Care Clinic/Center 261QA0600X
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

308 N Jackson St
Kosciusko, MS 39090-3322

Mailing address

308 N Jackson St
Kosciusko, MS 39090-3322
Phone (662) 289-7676

Other identifiers 4

IdentifierTypeStateIssuer
261QA0600XOtherMS1172V00000X
261QA0600XMedicaidMS
26QA0600XMedicaidMS
261QM1300XMedicaidMS

Other names 1

  • Imami Community Center Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Imani Community Outreach Center12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394668800000",
    "number": "1275977357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 N JACKSON ST",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "390903322",
            "telephone_number": "662-289-7676",
            "fax_number": "662-289-7688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 N JACKSON ST",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "390903322",
            "telephone_number": "662-289-7676",
            "fax_number": "662-289-7688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMANI COMMUNITY OUT REACH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-19",
        "last_updated": "2014-03-13",
        "status": "A",
        "authorized_official_last_name": "NDIAYE",
        "authorized_official_first_name": "ALLIE",
        "authorized_official_middle_name": "GLEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-289-7676",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1172V00000X",
            "identifier": "261QA0600X",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "261QA0600X",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "26QA0600X",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "261QM1300X",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Imami Community Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Kosciusko, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.