Provider Demographics
NPI:1043511132
Name:MIJN CORPORATION
Entity Type:Organization
Organization Name:MIJN CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NARCISO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-334-2273
Mailing Address - Street 1:3933 CAPTAIN JON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-5024
Mailing Address - Country:US
Mailing Address - Phone:702-457-1048
Mailing Address - Fax:
Practice Address - Street 1:3933 CAPTAIN JON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-5024
Practice Address - Country:US
Practice Address - Phone:702-457-1048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2000295.5713104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness