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General NPI Number Information
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NPI Number | 1780822254
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Entity Type | Organization
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Legal Business Name | CALVARY HEALTHCARE LLC
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Dates
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Enumeration Date | 01/21/2009
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Last Update Date | 04/16/2009
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Provider Practice Location Address
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Address Line | 10802 MONTICELLO DR
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City | GREAT FALLS
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State | VA
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Zip | 22066-4223
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Country | US
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Telephone | 301-335-8424
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Fax |
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Provider Business Mailing Address
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Address Line | 2205 MIDDLEFIELD CT
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City | DENVILLE
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State | NJ
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Zip | 07834-3463
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Country | US
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Telephone | 301-335-8424
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ROSEMARY H KUFUOR
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Credential | RN, BSN, MBA
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Telephone | 301-335-8424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 900-01-001
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License Number State | VA
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