Provider Demographics
NPI:1720971567
Name:A PLACE FOR MIMI LLC
Entity type:Organization
Organization Name:A PLACE FOR MIMI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TELLERIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-535-1408
Mailing Address - Street 1:15267 PERDIDO DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-5232
Mailing Address - Country:US
Mailing Address - Phone:321-413-7105
Mailing Address - Fax:
Practice Address - Street 1:15267 PERDIDO DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-5232
Practice Address - Country:US
Practice Address - Phone:321-413-7105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No253Z00000XAgenciesIn Home Supportive Care
No305S00000XManaged Care OrganizationsPoint of Service