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General NPI Number Information
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NPI Number | 1720971567
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Entity Type | Organization
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Legal Business Name | A PLACE FOR MIMI LLC
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Dates
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Enumeration Date | 05/30/2025
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 15267 PERDIDO DR
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City | ORLANDO
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State | FL
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Zip | 32828-5232
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Country | US
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Telephone | 321-413-7105
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Fax |
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Provider Business Mailing Address
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Address Line | 15267 PERDIDO DR
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City | ORLANDO
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State | FL
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Zip | 32828-5232
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Country | US
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Telephone | 321-413-7105
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANIA TELLERIA
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Credential |
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Telephone | 407-535-1408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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