Provider Demographics
NPI:1851069322
Name:CALVARY SENIOR CARE
Entity Type:Organization
Organization Name:CALVARY SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TANDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-559-2305
Mailing Address - Street 1:9650 BUSINESS CENTER DR # 110
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4536
Mailing Address - Country:US
Mailing Address - Phone:909-317-4749
Mailing Address - Fax:
Practice Address - Street 1:9650 BUSINESS CENTER DR # 110
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4536
Practice Address - Country:US
Practice Address - Phone:909-317-4749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care