Healthcare Provider Details

I. General information

NPI: 1487835112
Provider Name (Legal Business Name): MIMIS HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2007
Last Update Date: 11/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7142 DE PALMA ST
DOWNEY CA
90241-4386
US

IV. Provider business mailing address

7142 DE PALMA ST
DOWNEY CA
90241-4386
US

V. Phone/Fax

Practice location:
  • Phone: 562-806-9640
  • Fax: 562-806-9640
Mailing address:
  • Phone: 562-806-9640
  • Fax: 562-806-9640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. RAQUEL MONTERO
Title or Position: ADMINISTRATOR
Credential:
Phone: 562-682-1484