Provider Demographics
NPI:1104291020
Name:MIMI SUPPORTIVE HANDS .LLC
Entity type:Organization
Organization Name:MIMI SUPPORTIVE HANDS .LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUELA
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:248-943-6709
Mailing Address - Street 1:6 RIDGE DR APT 203
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-7016
Mailing Address - Country:US
Mailing Address - Phone:248-943-6709
Mailing Address - Fax:
Practice Address - Street 1:6 RIDGE DR APT 203
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45014
Practice Address - Country:US
Practice Address - Phone:248-943-6709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health