Provider Demographics
NPI:1558774398
Name:CALVERT MANOR HEALTHCARE CENTER, LLC
Entity Type:Organization
Organization Name:CALVERT MANOR HEALTHCARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:410-729-8406
Mailing Address - Street 1:1881 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:RISING SUN
Mailing Address - State:MD
Mailing Address - Zip Code:21911-2018
Mailing Address - Country:US
Mailing Address - Phone:410-658-6555
Mailing Address - Fax:410-658-9717
Practice Address - Street 1:1881 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911-2018
Practice Address - Country:US
Practice Address - Phone:410-658-6555
Practice Address - Fax:410-658-9717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility