Provider Demographics
NPI:1164065728
Name:IMANI AND UNIDAD, INC.
Entity Type:Organization
Organization Name:IMANI AND UNIDAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-288-2887
Mailing Address - Street 1:PO BOX 4305
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46634-4305
Mailing Address - Country:US
Mailing Address - Phone:574-288-2887
Mailing Address - Fax:274-288-2801
Practice Address - Street 1:234 CHAPIN ST STE B
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-2571
Practice Address - Country:US
Practice Address - Phone:574-288-2887
Practice Address - Fax:574-288-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health