Mims Manor LLC

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

MHL065170 Issued in NC

Legal business name

MIMS MANOR LLC

Practice address

621 Plymouth Dr
Wilmington, NC 28405-2544

Phone

(910) 796-9040

NPI assigned

Dec 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Terry Mims

Title

Owner

Phone

(910) 273-5838

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184025600000",
    "number": "1801950191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 BROOKCROSSING DR",
            "address_2": "VILLAGE AT LAKEWOOD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283069790",
            "telephone_number": "910-273-5838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 PLYMOUTH DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284052544",
            "telephone_number": "910-796-9040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIMS MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2007-07-10",
        "status": "A",
        "authorized_official_last_name": "MIMS",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-273-5838",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL065170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridget Dixon Milliken, LCMHC, LCASA
• McCall Milliken
• Camme Beckerdite Millis, LPN
• Luke Mills
• Makayla Jessica Bowling Mills, MSW
• Lesley Marie Mims, B.A.
• Mind Haven Mental Health PLLC
• Mindful Pathways Psychiatric Services
• Kristen Ann Mingia, PMHNP
• Sarah Helen Miniello, CRNA

• Emotionally Disturbed Childrens' Residential Treatment Facility in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.