Provider Demographics
NPI:1992098099
Name:CALVERT SENIOR SERVICES LLC
Entity type:Organization
Organization Name:CALVERT SENIOR SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-919-7495
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:CALVERT
Mailing Address - State:TX
Mailing Address - Zip Code:77837-0159
Mailing Address - Country:US
Mailing Address - Phone:979-364-2391
Mailing Address - Fax:979-364-2798
Practice Address - Street 1:701 E BROWNING ST
Practice Address - Street 2:
Practice Address - City:CALVERT
Practice Address - State:TX
Practice Address - Zip Code:77837-7593
Practice Address - Country:US
Practice Address - Phone:979-364-2391
Practice Address - Fax:979-364-2798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004365313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN