Provider Demographics
NPI:1275408841
Name:IMANI SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:IMANI SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BYAOMBE
Authorized Official - Middle Name:LILLIAN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-995-1295
Mailing Address - Street 1:4804 TARA VIEW RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7805
Mailing Address - Country:US
Mailing Address - Phone:352-995-1295
Mailing Address - Fax:
Practice Address - Street 1:4804 TARA VIEW RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7805
Practice Address - Country:US
Practice Address - Phone:352-995-1295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No251E00000XAgenciesHome Health
No342000000XTransportation ServicesTransportation Network Company