Healthcare Provider Details

I. General information

NPI: 1619792546
Provider Name (Legal Business Name): CALM COVE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2024
Last Update Date: 11/16/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 W GUADALUPE RD STE 7
MESA AZ
85202-7246
US

IV. Provider business mailing address

2655 W GUADALUPE RD STE 7
MESA AZ
85202-7246
US

V. Phone/Fax

Practice location:
  • Phone: 314-494-7603
  • Fax:
Mailing address:
  • Phone: 314-494-7603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CERMILLIA WILLIAMS
Title or Position: DIRECTOR/OWNER
Credential: MSW,MBS,PSRR,CHW
Phone: 314-494-7603