Healthcare Provider Details

I. General information

NPI: 1881119550
Provider Name (Legal Business Name): CALVARY HOME SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6808 N 77TH LN
GLENDALE AZ
85303-2915
US

IV. Provider business mailing address

6808 N 77TH LN
GLENDALE AZ
85303-2915
US

V. Phone/Fax

Practice location:
  • Phone: 480-404-4159
  • Fax:
Mailing address:
  • Phone: 480-404-4159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number8326985
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: WATSON ANGELA
Title or Position: DIRECTOR
Credential:
Phone: 480-404-4159