Provider Demographics
NPI:1881119550
Name:CALVARY HOME CARE SERVICES INC
Entity type:Organization
Organization Name:CALVARY HOME CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUWAKEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:GBANGBALASA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-919-3614
Mailing Address - Street 1:4360 W. ALTA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339
Mailing Address - Country:US
Mailing Address - Phone:615-616-3614
Mailing Address - Fax:
Practice Address - Street 1:4360 W. ALTA VISTA RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339
Practice Address - Country:US
Practice Address - Phone:615-616-3614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 311Z00000X, 320900000X
AZ8326985253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253J00000XAgenciesFoster Care Agency
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility