1336690692 NPI number — DONGLEN INVESTMENTS LLC

Table of content: (NPI 1336690692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336690692 NPI number — DONGLEN INVESTMENTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DONGLEN INVESTMENTS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SILVER CREST HOME
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336690692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2011 IMPERIAL EAGLE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KISSIMMEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34746-1914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-559-0566
Provider Business Mailing Address Fax Number:
866-421-5678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 DARLINGTON CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34758-3049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-201-7259
Provider Business Practice Location Address Fax Number:
866-421-5678
Provider Enumeration Date:
10/20/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
DONAVON
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
954-559-0566

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  AL12867 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 018809900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116908600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".