Provider Demographics
NPI:1255975751
Name:AMANI PERSONAL CARE AGENCY LLC
Entity type:Organization
Organization Name:AMANI PERSONAL CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GODFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-456-7979
Mailing Address - Street 1:3801 MONARCH DR STE E
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-5500
Mailing Address - Country:US
Mailing Address - Phone:262-456-7979
Mailing Address - Fax:
Practice Address - Street 1:3801 MONARCH DR STE E
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-5500
Practice Address - Country:US
Practice Address - Phone:262-456-7979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care