Provider Demographics
NPI:1003536012
Name:IMANI WOUNDCARE SERVICES INC
Entity Type:Organization
Organization Name:IMANI WOUNDCARE SERVICES INC
Other - Org Name:WC HOME SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:909-614-3039
Mailing Address - Street 1:27555 YNEZ RD STE 210
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4678
Mailing Address - Country:US
Mailing Address - Phone:909-614-3039
Mailing Address - Fax:
Practice Address - Street 1:27555 YNEZ RD STE 210
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4678
Practice Address - Country:US
Practice Address - Phone:909-614-3039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMANI WOUNDCARE SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-30
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA334700186OtherHCO NUMBER