1336142702 NPI number — CALVERT MANOR HEALTHCARE CENTER, INC.

Table of content: (NPI 1336142702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336142702 NPI number — CALVERT MANOR HEALTHCARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALVERT MANOR HEALTHCARE CENTER, INC.
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:
Provider Other Organization Name Type Code:
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:
1336142702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1881 TELEGRAPH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RISING SUN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21911-2018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-658-6555
Provider Business Mailing Address Fax Number:
410-658-9717

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1881 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RISING SUN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21911-2018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-658-6555
Provider Business Practice Location Address Fax Number:
410-658-9717
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CULBERSON
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
ASSISTANT BUSINESS MANAGER
Authorized Official Telephone Number:
410-658-6555

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  07AL0010 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 314000000X , with the licence number: 07001 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 02WZ . This is a "BC/BS OF ILLINOIS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 02WZ . This is a "BC/BS OF WEST VIRGINIA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 02WZ . This is a "FREESTATE HEALTH PLAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 59003901 . This is a "MARYLAND BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 69010000100322 . This is a "BC/BS GENERAL MOTORS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 02WZ . This is a "EMPIRE BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 02WZ . This is a "IOWA BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 30018856 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 69010000100322 . This is a "BC/BS NATIONAL ACCOUNT" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 02WZ . This is a "BC/BS OF MICHIGAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 953268980035 . This is a "TRI CARE FOR LIFE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 615806 . This is a "COMBINED INSURANCE CO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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