Provider Demographics
NPI:1588650618
Name:CALVERT CITY CONVALESCENT CENTER, INC
Entity Type:Organization
Organization Name:CALVERT CITY CONVALESCENT CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST BUSINESS ADMN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-395-4124
Mailing Address - Street 1:1201 5TH AVE
Mailing Address - Street 2:PO BOX 7
Mailing Address - City:CALVERT CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42029-8233
Mailing Address - Country:US
Mailing Address - Phone:270-395-4124
Mailing Address - Fax:270-395-4962
Practice Address - Street 1:1201 5TH AVE
Practice Address - Street 2:
Practice Address - City:CALVERT CITY
Practice Address - State:KY
Practice Address - Zip Code:42029-8233
Practice Address - Country:US
Practice Address - Phone:270-395-4124
Practice Address - Fax:270-395-4962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12500443Medicaid
KY12500443Medicaid