Provider Demographics
NPI:1720270630
Name:IMANI HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:IMANI HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONNETT
Authorized Official - Middle Name:
Authorized Official - Last Name:OUTLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-725-1268
Mailing Address - Street 1:6118 IRISH HILL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77053-3428
Mailing Address - Country:US
Mailing Address - Phone:832-887-8992
Mailing Address - Fax:713-669-1091
Practice Address - Street 1:6118 IRISH HILL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77053-3428
Practice Address - Country:US
Practice Address - Phone:832-887-8992
Practice Address - Fax:713-669-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2165261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080458501Medicaid
TX00369NMedicare PIN