Healthcare Provider Details

I. General information

NPI: 1427822717
Provider Name (Legal Business Name): CATRINA J MIMS CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17669 MCINTYRE ST
DETROIT MI
48219-2369
US

IV. Provider business mailing address

17669 MCINTYRE ST
DETROIT MI
48219-2369
US

V. Phone/Fax

Practice location:
  • Phone: 833-523-7422
  • Fax:
Mailing address:
  • Phone: 313-731-0053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: CATRINA MIMS
Title or Position: ADMINISTRATOR
Credential:
Phone: 248-378-7145