Provider Demographics
NPI:1598420986
Name:MIMI CARES PERSONAL CARE
Entity Type:Organization
Organization Name:MIMI CARES PERSONAL CARE
Other - Org Name:MIMI CARES PERSONAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CMA/CNA
Authorized Official - Prefix:
Authorized Official - First Name:MIYOSHI
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-973-9782
Mailing Address - Street 1:320 LANIER AVE W STE 248
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1600
Mailing Address - Country:US
Mailing Address - Phone:678-973-9782
Mailing Address - Fax:
Practice Address - Street 1:320 LANIER AVE W STE 248
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1600
Practice Address - Country:US
Practice Address - Phone:678-973-9782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA87-2800196OtherHOME HEALTH AID
GA87-2800196Medicaid