Provider Demographics
NPI:1902098908
Name:CALVARY ELDERLY HOME HELP PROGRAM
Entity Type:Organization
Organization Name:CALVARY ELDERLY HOME HELP PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ASHMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-676-7199
Mailing Address - Street 1:1709 W LINCOLN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61605
Mailing Address - Country:US
Mailing Address - Phone:309-673-1709
Mailing Address - Fax:309-676-7193
Practice Address - Street 1:1709 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605
Practice Address - Country:US
Practice Address - Phone:309-673-1709
Practice Address - Fax:309-676-7193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health