Provider Demographics
NPI:1457653180
Name:IMANI HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:IMANI HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:RACHEL
Authorized Official - Last Name:MBUGUA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-965-1082
Mailing Address - Street 1:2312 CORRAL DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-8911
Mailing Address - Country:US
Mailing Address - Phone:817-965-1082
Mailing Address - Fax:817-728-5599
Practice Address - Street 1:2312 CORRAL DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-8911
Practice Address - Country:US
Practice Address - Phone:817-965-1082
Practice Address - Fax:817-728-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health