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General NPI Number Information
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NPI Number | 1396940177
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Entity Type | Organization
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Legal Business Name | MIMS FAMILY CARE HOME
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 6401 MIMS RD
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-9561
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Country | US
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Telephone | 919-552-6455
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Fax | 919-567-5313
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Provider Business Mailing Address
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Address Line | 6401 MIMS RD
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-9561
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Country | US
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Telephone | 919-552-6455
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Fax | 919-567-5313
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | MRS. JOYCE MIMS
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Credential |
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Telephone | 919-552-6455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | FCL092045
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License Number State | NC
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