Provider Demographics
NPI:1649804956
Name:CALVARY HOME CARE L.L.C.
Entity type:Organization
Organization Name:CALVARY HOME CARE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMPSON
Authorized Official - Middle Name:
Authorized Official - Last Name:KWAKYEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-755-5058
Mailing Address - Street 1:867 QUEEN ANNE RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4642
Mailing Address - Country:US
Mailing Address - Phone:201-755-5058
Mailing Address - Fax:
Practice Address - Street 1:362 CEDAR LN
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3447
Practice Address - Country:US
Practice Address - Phone:201-755-5058
Practice Address - Fax:201-836-3989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health