Provider Demographics
NPI:1528384120
Name:MARY'S CARE HOME
Entity Type:Organization
Organization Name:MARY'S CARE HOME
Other - Org Name:CALKINS TRANSPORT LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CALKIMS
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:928-692-6721
Mailing Address - Street 1:9288 N LOST SAGE DR
Mailing Address - Street 2:8746 STOCKTON HILL RD #17
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-9359
Mailing Address - Country:US
Mailing Address - Phone:928-692-6721
Mailing Address - Fax:928-692-5408
Practice Address - Street 1:9288 N LOST SAGE DR
Practice Address - Street 2:8746 STOCKON HILL RD #17
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-9359
Practice Address - Country:US
Practice Address - Phone:928-692-6721
Practice Address - Fax:928-692-5408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)