Provider Demographics
NPI:1164030292
Name:CALVARY HOME HEALTH, LLC
Entity Type:Organization
Organization Name:CALVARY HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOMI
Authorized Official - Middle Name:ROTIMI
Authorized Official - Last Name:OGUNBODEDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:191-975-8195
Mailing Address - Street 1:1300 TRIBUTE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3214
Mailing Address - Country:US
Mailing Address - Phone:919-758-1955
Mailing Address - Fax:
Practice Address - Street 1:1300 TRIBUTE CENTER DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3214
Practice Address - Country:US
Practice Address - Phone:919-758-1955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health