Provider Demographics
NPI:1700401957
Name:IMANI HOME CARE LIVING LLC
Entity Type:Organization
Organization Name:IMANI HOME CARE LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MASOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-276-8277
Mailing Address - Street 1:4425 W OLIVE AVE STE 144
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-3844
Mailing Address - Country:US
Mailing Address - Phone:623-230-2464
Mailing Address - Fax:
Practice Address - Street 1:8539 W HAZELWOOD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-1534
Practice Address - Country:US
Practice Address - Phone:480-276-8277
Practice Address - Fax:866-837-9226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-13
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health