1336142702 NPI number — CALVERT MANOR HEALTHCARE CENTER, INC.

Table of Contents

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:
09/11/2025
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: "N" .
  • 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: "Y" .

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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