Provider Demographics
NPI:1740428895
Name:CALVINELLE CARE CONCEPT, LLC
Entity type:Organization
Organization Name:CALVINELLE CARE CONCEPT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GAYON
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:305-308-2728
Mailing Address - Street 1:1627 NW 62ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-7900
Mailing Address - Country:US
Mailing Address - Phone:305-308-2728
Mailing Address - Fax:
Practice Address - Street 1:1627 NW 62ND TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-7900
Practice Address - Country:US
Practice Address - Phone:305-308-2728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006246600Medicaid