Provider Demographics
NPI:1871783357
Name:CALVARY CARE GROUP, INC.
Entity type:Organization
Organization Name:CALVARY CARE GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUBUNMI
Authorized Official - Middle Name:TABITHA
Authorized Official - Last Name:ADENIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:979-645-0336
Mailing Address - Street 1:16227 CYPRESS TRACE DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-1679
Mailing Address - Country:US
Mailing Address - Phone:979-645-0336
Mailing Address - Fax:281-256-8574
Practice Address - Street 1:1432 SOUTH FRONT
Practice Address - Street 2:
Practice Address - City:BELLVILLE
Practice Address - State:TX
Practice Address - Zip Code:77418
Practice Address - Country:US
Practice Address - Phone:979-645-0336
Practice Address - Fax:281-256-8574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010859251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health