Provider Demographics
NPI:1669643730
Name:MIMI'S ADULT FAMILY HOME
Entity Type:Organization
Organization Name:MIMI'S ADULT FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARETA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-443-5138
Mailing Address - Street 1:811 10TH ST NE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:253-735-6689
Practice Address - Street 1:811 10TH ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4127
Practice Address - Country:US
Practice Address - Phone:253-735-6689
Practice Address - Fax:253-735-6689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA568001311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home