Provider Demographics
NPI:1750511291
Name:CARIBBEAN COMMUNITY CONNECTION OF ORLANDO, INC.
Entity type:Organization
Organization Name:CARIBBEAN COMMUNITY CONNECTION OF ORLANDO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANJIRO
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:407-473-1442
Mailing Address - Street 1:620 NEW MEXICO WOODS CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-7552
Mailing Address - Country:US
Mailing Address - Phone:407-473-1442
Mailing Address - Fax:407-522-7617
Practice Address - Street 1:122 W SPROULE AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5048
Practice Address - Country:US
Practice Address - Phone:407-473-7616
Practice Address - Fax:321-428-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1228Medicaid