Provider Demographics
NPI:1235766320
Name:IMANA RN LLC
Entity Type:Organization
Organization Name:IMANA RN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ALEGHE
Authorized Official - Last Name:IMANA
Authorized Official - Suffix:
Authorized Official - Credentials:RN REGISTERED NURSE
Authorized Official - Phone:347-282-0458
Mailing Address - Street 1:416 N. FULTON AVENUE
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-2214
Mailing Address - Country:US
Mailing Address - Phone:347-282-0458
Mailing Address - Fax:914-699-2649
Practice Address - Street 1:416 N. FULTON AVENUE
Practice Address - Street 2:SUITE 4000
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-2214
Practice Address - Country:US
Practice Address - Phone:347-282-0458
Practice Address - Fax:914-699-2649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty