Provider Demographics
NPI:1013134667
Name:CALVARY CENTER INC
Entity type:Organization
Organization Name:CALVARY CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-279-1468
Mailing Address - Street 1:720 E MONTEBELLO
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014
Mailing Address - Country:US
Mailing Address - Phone:602-279-1468
Mailing Address - Fax:602-279-3090
Practice Address - Street 1:720 E MONTEBELLO
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014
Practice Address - Country:US
Practice Address - Phone:602-279-1468
Practice Address - Fax:602-279-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH 2397324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ847634OtherAHCCCS