Provider Demographics
NPI:1336690692
Name:DONGLEN INVESTMENTS LLC
Entity Type:Organization
Organization Name:DONGLEN INVESTMENTS LLC
Other - Org Name:SILVER CREST HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONAVON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-559-0566
Mailing Address - Street 1:2011 IMPERIAL EAGLE PL
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-1914
Mailing Address - Country:US
Mailing Address - Phone:954-559-0566
Mailing Address - Fax:866-421-5678
Practice Address - Street 1:1010 DARLINGTON CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-3049
Practice Address - Country:US
Practice Address - Phone:407-201-7259
Practice Address - Fax:866-421-5678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12867310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018809900Medicaid