Provider Demographics
NPI:1295865970
Name:IMANI HOSPITALITY HOMECARE
Entity Type:Organization
Organization Name:IMANI HOSPITALITY HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONTRELL
Authorized Official - Middle Name:V
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-917-9015
Mailing Address - Street 1:501 DALE ST N # 103
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-1914
Mailing Address - Country:US
Mailing Address - Phone:651-917-9015
Mailing Address - Fax:651-645-7739
Practice Address - Street 1:501 DALE ST N # 103
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-1914
Practice Address - Country:US
Practice Address - Phone:651-917-9015
Practice Address - Fax:651-645-7739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization