Provider Demographics
NPI:1578647020
Name:CALVARY HEALTH CARE, INC.
Entity Type:Organization
Organization Name:CALVARY HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FABIAN
Authorized Official - Middle Name:ONYEKA
Authorized Official - Last Name:OGALA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-678-1950
Mailing Address - Street 1:2840 KELLER SPRINGS RD
Mailing Address - Street 2:STE 801
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-4829
Mailing Address - Country:US
Mailing Address - Phone:214-678-1950
Mailing Address - Fax:214-678-1940
Practice Address - Street 1:2840 KELLER SPRINGS RD
Practice Address - Street 2:STE 801
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006
Practice Address - Country:US
Practice Address - Phone:214-678-1950
Practice Address - Fax:214-678-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2866048Medicaid
747092Medicare PIN
TX2866048Medicaid