Provider Demographics
NPI:1164026175
Name:CALTHEDRA RELIABLE SERVICE
Entity Type:Organization
Organization Name:CALTHEDRA RELIABLE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CALTHEDRA
Authorized Official - Middle Name:LANEE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-786-6648
Mailing Address - Street 1:PO BOX 8277
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36689-0277
Mailing Address - Country:US
Mailing Address - Phone:251-786-6648
Mailing Address - Fax:
Practice Address - Street 1:1253 SKIPPER DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-5649
Practice Address - Country:US
Practice Address - Phone:251-786-6648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health