# MIMS MANOR LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801950191
- **Authorized official:** MRS. TERRY MIMS (OWNER)
- **Authorized official phone:** (910) 273-5838

## Contact information

- **Practice address:** 621 PLYMOUTH DR, WILMINGTON, NC 28405-2544
- **Practice address phone:** (910) 796-9040
- **Mailing address:** 3020 BROOKCROSSING DR, VILLAGE AT LAKEWOOD, FAYETTEVILLE, NC 28306-9790
- **Mailing address phone:** (910) 273-5838

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL065170 | NC | Yes |

## Other

- **Enumeration date:** 12/20/2006
- **Last updated:** 07/10/2007