Provider Demographics
NPI:1033379193
Name:IMANI PERSONAL CARE HOMES
Entity Type:Organization
Organization Name:IMANI PERSONAL CARE HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:314-395-5245
Mailing Address - Street 1:11881 LAPADERA LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033
Mailing Address - Country:US
Mailing Address - Phone:314-395-5245
Mailing Address - Fax:
Practice Address - Street 1:11881 LAPADERA LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033
Practice Address - Country:US
Practice Address - Phone:314-395-5245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)