Provider Demographics
NPI:1942419700
Name:IMANI WORKS CORPORATION
Entity Type:Organization
Organization Name:IMANI WORKS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERDENA
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:540-672-9000
Mailing Address - Street 1:111 SHORT ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:VA
Mailing Address - Zip Code:22960-1651
Mailing Address - Country:US
Mailing Address - Phone:540-672-9000
Mailing Address - Fax:540-672-2710
Practice Address - Street 1:111 SHORT ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:VA
Practice Address - Zip Code:22960-1651
Practice Address - Country:US
Practice Address - Phone:540-672-9000
Practice Address - Fax:540-672-2710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2113126Medicaid