Provider Demographics
NPI:1093005019
Name:IMANI RESOURCE SERVICE
Entity Type:Organization
Organization Name:IMANI RESOURCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:FOSTER
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-314-3315
Mailing Address - Street 1:4790 ALLRAND RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-7207
Mailing Address - Country:US
Mailing Address - Phone:901-314-3315
Mailing Address - Fax:901-365-8090
Practice Address - Street 1:4790 ALLRAND RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-7207
Practice Address - Country:US
Practice Address - Phone:901-314-3315
Practice Address - Fax:901-365-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)