Healthcare Provider Details

I. General information

NPI: 1992098099
Provider Name (Legal Business Name): CALVERT SENIOR SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E BROWNING ST
CALVERT TX
77837-7593
US

IV. Provider business mailing address

PO BOX 159
CALVERT TX
77837-0159
US

V. Phone/Fax

Practice location:
  • Phone: 979-364-2391
  • Fax: 979-364-2798
Mailing address:
  • Phone: 979-364-2391
  • Fax: 979-364-2798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number004365
License Number StateTX

VIII. Authorized Official

Name: MR. ALAN DUANE PETERSON
Title or Position: MANAGING MEMBER
Credential:
Phone: 817-919-7495