Healthcare Provider Details

I. General information

NPI: 1720925159
Provider Name (Legal Business Name): MINI STAYS OF TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S MCDOWELL ST STE 1251761
CHARLOTTE NC
28204-2623
US

IV. Provider business mailing address

301 S MCDOWELL ST STE 1251761
CHARLOTTE NC
28204-2623
US

V. Phone/Fax

Practice location:
  • Phone: 501-352-3262
  • Fax:
Mailing address:
  • Phone: 501-352-3262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MAKIAH POWELL
Title or Position: OPERATOR
Credential:
Phone: 501-352-3262