Provider Demographics
NPI:1679151203
Name:CALVARY CENTER INC
Entity type:Organization
Organization Name:CALVARY CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BOEHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-535-3384
Mailing Address - Street 1:720 E MONTEBELLO AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2543
Mailing Address - Country:US
Mailing Address - Phone:602-535-3384
Mailing Address - Fax:602-279-3090
Practice Address - Street 1:1730 E MCNAIR DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-5000
Practice Address - Country:US
Practice Address - Phone:602-535-3384
Practice Address - Fax:602-279-3090
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:200380961
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-02
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation