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1336142702

NPI Code Detail

MEDICARE: CALVERT MANOR HEALTHCARE CENTER, INC.

MEDICARE: CALVERT MANOR HEALTHCARE CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	07AL0010	MD
2	314000000X	Skilled Nursing Facility	07001	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02WZ	OTHER	MD	BC/BS OF ILLINOIS
2	02WZ	OTHER	MD	BC/BS OF WEST VIRGINIA
3	02WZ	OTHER	MD	FREESTATE HEALTH PLAN
4	59003901	OTHER	MD	MARYLAND BC/BS
5	69010000100322	OTHER	MD	BC/BS GENERAL MOTORS
6	02WZ	OTHER	MD	EMPIRE BC/BS
7	02WZ	OTHER	MD	IOWA BC/BS
8	30018856	OTHER	MD	KEYSTONE MERCY
9	69010000100322	OTHER	MD	BC/BS NATIONAL ACCOUNT
10	02WZ	OTHER	MD	BC/BS OF MICHIGAN
11	953268980035	OTHER	MD	TRI CARE FOR LIFE
12	615806	OTHER	MD	COMBINED INSURANCE CO

General Provider Information

NPI Number	:	1336142702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALVERT MANOR HEALTHCARE CENTER, INC.

Provider Business Mailing Address
First Line	:	1881 TELEGRAPH RD
Second Line	:
City	:	RISING SUN
State	:	MD
Zip	:	21911-2018
Country	:	US
Telephone Number	:	410-658-6555
Fax Number	:	410-658-9717

Provider Business Practice Location Address
First Line	:	1881 TELEGRAPH RD
Second Line	:
City	:	RISING SUN
State	:	MD
Zip	:	21911-2018
Country	:	US
Telephone Number	:	410-658-6555
Fax Number	:	410-658-9717

Authorized Official
Title or Position	:	ASSISTANT BUSINESS MANAGER
Name	:	MRS. DONNA R CULBERSON
Credential	:
Telephone Number	:	410-658-6555

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	09/11/2025

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1932443447 — TERESA SMITHERS
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Directions to “CALVERT MANOR HEALTHCARE CENTER, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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