MEDICARE: MIMI'S HEALTHCARE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	372600000X	Adult Companion
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
3	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
4	253Z00000X	In Home Supportive Care Agency
5	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1962119404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIMI'S HEALTHCARE SERVICES

Provider Business Mailing Address
First Line	:	10123 TOWHEE AVE
Second Line	:
City	:	ADELPHI
State	:	MD
Zip	:	20783-1209
Country	:	US
Telephone Number	:	240-447-7029
Fax Number	:

Provider Business Practice Location Address
First Line	:	10123 TOWHEE AVE
Second Line	:
City	:	ADELPHI
State	:	MD
Zip	:	20783-1209
Country	:	US
Telephone Number	:	240-447-7029
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROMUALD TCHOUGOUE
Credential	:
Telephone Number	:	240-447-7029

Provider Enumeration Date	:	11/03/2022
Last Update Date	:	04/11/2023

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Directions to “MIMI'S HEALTHCARE SERVICES ” Practice Location

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