MEDICARE: CALVIN CARE AGENCY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372500000X	Chore Provider

General Provider Information

NPI Number	:	1497692412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALVIN CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	15334 HEYDEN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48223-1745
Country	:	US
Telephone Number	:	313-288-8426
Fax Number	:

Provider Business Practice Location Address
First Line	:	15334 HEYDEN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48223-1745
Country	:	US
Telephone Number	:	313-288-8426
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DENZEL LORENZO JOHNSON
Credential	:
Telephone Number	:	313-778-3098

Provider Enumeration Date	:	04/29/2026
Last Update Date	:	05/05/2026

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