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General NPI Number Information
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NPI Number | 1336969161
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Entity Type | Organization
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Legal Business Name | CALVARY HOME HEALTHCARE SERVICES, LLC
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 02/18/2026
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Provider Practice Location Address
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Address Line | 1106 N STATE HIGHWAY 360 STE 303
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City | GRAND PRAIRIE
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State | TX
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Zip | 75050-2511
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Country | US
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Telephone | 469-909-1511
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Fax | 469-909-1512
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Provider Business Mailing Address
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Address Line | 1106 N STATE HIGHWAY 360 STE 303
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City | GRAND PRAIRIE
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State | TX
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Zip | 75050-2511
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Country | US
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Telephone | 469-909-1511
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Fax | 469-909-1512
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Authorized Official
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Title or Position | PRESIDENT
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Name | LOUIS TENJE MANGONG
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Credential |
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Telephone | 408-449-0492
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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