Provider Demographics
NPI:1649036674
Name:MIMI'S ASSISTED LIVING FACILITY, LLC
Entity type:Organization
Organization Name:MIMI'S ASSISTED LIVING FACILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA,COTA,CLT
Authorized Official - Phone:316-993-0437
Mailing Address - Street 1:1019 GROVER CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1425
Mailing Address - Country:US
Mailing Address - Phone:316-993-0437
Mailing Address - Fax:
Practice Address - Street 1:6404 BROOKGROVE CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-3012
Practice Address - Country:US
Practice Address - Phone:945-444-0564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-27
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health