=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316044555
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CALVERT HEALTH PARTNERS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 672 BERKMAR CIR
-----------------------------------------------------
City | CHARLOTTESVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22901-1464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-974-9015
-----------------------------------------------------
Fax | 434-974-9092
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 E PRATT ST STE 253
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21202-3041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-230-0001
-----------------------------------------------------
Fax | 410-230-0031
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE VICE PRESIDENT
-----------------------------------------------------
Name | JOSEPH DOMNIC PETTI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-230-0001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------