Basic Information
| Provider Information | |||||||||
| NPI: | 1558774398 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALVERT MANOR HEALTHCARE CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1881 TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | RISING SUN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219112018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106586555 | ||||||||
| FaxNumber: | 4106589717 | ||||||||
| Practice Location | |||||||||
| Address1: | 1881 TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | RISING SUN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219112018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106586555 | ||||||||
| FaxNumber: | 4106589717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2014 | ||||||||
| LastUpdateDate: | 01/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | OWENS | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4107298406 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LNHA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.