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General NPI Number Information
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NPI Number | 1184111007
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Entity Type | Organization
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Legal Business Name | MIMI'S CARE HOME, LLC
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Dates
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Enumeration Date | 04/16/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 3055 S PIONEER WAY
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City | LAS VEGAS
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State | NV
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Zip | 89117-3244
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Country | US
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Telephone | 702-767-5220
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Fax |
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Provider Business Mailing Address
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Address Line | 3055 S PIONEER WAY
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City | LAS VEGAS
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State | NV
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Zip | 89117-3244
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Country | US
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Telephone | 702-767-5220
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MS. MIMI ASFAW
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Credential |
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Telephone | 702-767-5220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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