Healthcare Provider Details

I. General information

NPI: 1649804956
Provider Name (Legal Business Name): CALVARY HOME CARE L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

362 CEDAR LN
TEANECK NJ
07666-3447
US

IV. Provider business mailing address

867 QUEEN ANNE RD
TEANECK NJ
07666-4642
US

V. Phone/Fax

Practice location:
  • Phone: 201-755-5058
  • Fax: 201-836-3989
Mailing address:
  • Phone: 201-755-5058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SAMPSON KWAKYEH
Title or Position: OWNER
Credential:
Phone: 201-755-5058