Provider Demographics
NPI:1417721879
Name:MIMS, CATRINA
Entity type:Individual
Prefix:
First Name:CATRINA
Middle Name:
Last Name:MIMS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15900 W 10 MILE RD STE 211
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2079
Mailing Address - Country:US
Mailing Address - Phone:248-378-7145
Mailing Address - Fax:
Practice Address - Street 1:17669 MCINTYRE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-2369
Practice Address - Country:US
Practice Address - Phone:248-274-4435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No253Z00000XAgenciesIn Home Supportive Care