Provider Demographics
NPI:1821338799
Name:CALVINELLE CARE CONCEPT, LLC
Entity Type:Organization
Organization Name:CALVINELLE CARE CONCEPT, LLC
Other - Org Name:CALVINELLE ADULT HOME ALF, #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GAYON
Authorized Official - Middle Name:DIANA
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-308-2728
Mailing Address - Street 1:6151 MIRAMAR PKWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3970
Mailing Address - Country:US
Mailing Address - Phone:305-308-2728
Mailing Address - Fax:305-640-8316
Practice Address - Street 1:1786 NW 47TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-4071
Practice Address - Country:US
Practice Address - Phone:305-308-2728
Practice Address - Fax:305-640-8316
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALVINELLECCARE CONCEPT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-28
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL116353104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006246600Medicaid