Provider Demographics
NPI:1508491861
Name:AMANI HEALTH CARE SERVICES, LLC
Entity Type:Organization
Organization Name:AMANI HEALTH CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING COORDINATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:MOMANYI
Authorized Official - Last Name:NYAMARI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:952-564-9086
Mailing Address - Street 1:1705 SOUTHCROSS DR W STE 105
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-7012
Mailing Address - Country:US
Mailing Address - Phone:952-683-1628
Mailing Address - Fax:952-683-1629
Practice Address - Street 1:1705 SOUTHCROSS DR W STE 105
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-7012
Practice Address - Country:US
Practice Address - Phone:952-683-1628
Practice Address - Fax:952-683-1629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA116450100OtherMA, CADI WAIVER
MNA836410600OtherMA, CADI WAIVER