Healthcare Provider Details

I. General information

NPI: 1962119404
Provider Name (Legal Business Name): MIMI'S HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10123 TOWHEE AVE
ADELPHI MD
20783-1209
US

IV. Provider business mailing address

10123 TOWHEE AVE
ADELPHI MD
20783-1209
US

V. Phone/Fax

Practice location:
  • Phone: 240-447-7029
  • Fax:
Mailing address:
  • Phone: 240-447-7029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROMUALD TCHOUGOUE
Title or Position: OWNER
Credential:
Phone: 240-447-7029