Provider Demographics
NPI:1891806980
Name:CALVARY FELLOWSHIP HOMES, INC.
Entity Type:Organization
Organization Name:CALVARY FELLOWSHIP HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-393-0711
Mailing Address - Street 1:502 ELIZABETH DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4406
Mailing Address - Country:US
Mailing Address - Phone:717-393-0711
Mailing Address - Fax:717-393-0998
Practice Address - Street 1:502 ELIZABETH DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4406
Practice Address - Country:US
Practice Address - Phone:717-393-0711
Practice Address - Fax:717-393-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA030102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007452430001Medicaid
PA0007452430001Medicaid