NPIMap

Organization Active NPI

Cordova Bay LLC

Doing business as Calvert Home Health

  • Home Health Agency
  • Lubbock, TX
National Provider Identifier
1144461476
Registry record updated Dec 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
012272 Issued in TX
Legal business name
CORDOVA BAY LLC
Doing business as
Calvert Home Health
Practice address
10207 Indiana Ave
Lubbock, TX 79423-4909
Phone
(806) 712-1110
NPI assigned
Mar 17, 2009
Last updated
Dec 18, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Karen Elaine Vahlberg
Title
Ceo
Phone
(405) 329-4545

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 012272 TX Primary

Addresses

Primary practice location

10207 Indiana Ave
Lubbock, TX 79423-4909

Mailing address

2411 Springer Dr
Norman, OK 73069-3955
Phone (405) 329-4545

Other identifiers 2

IdentifierTypeStateIssuer
204233501MedicaidTX
457514OtherTXMEDICARE PROVIDER NUMBER

Other names 1

  • Calvert Home Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090318000670 TX Part A Provider - Home Health Agency 0648336123 Practice locations: Plainview, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144461476. Details of each certification follow.

Home health agency certification: CCN 457514

Legal name
CORDOVA BAY LLC
Doing business as
CALVERT HOME HEALTH CARE LTD
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Sep 21, 1983
Last certification
Jul 21, 2021
Ownership / control type
Proprietary
Organization structure
PartnershipProprietary
Enrollment address
2101 W 24TH St
Plainview, TX 79072-2041

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Calvert Home Health Care, LTDCCN 457514 · All quality measures
Overall star rating
3.5 of 5
Ownership
Proprietary
Certified
Sep 21, 1983
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Calvert Home Health2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

126 Clubview Dr
Levelland, TX 79336
Phone (806) 894-2375

600 N Marienfeld St
Ste 319
Midland, TX 79701
Phone (432) 686-0900

602 N Baird St
#121F
Midland, TX 79701
Phone (432) 686-0900

117 E Main St
Ste 300
Post, TX 79356
Phone (806) 675-7321

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Julie a Clarkson Individual Corporate OfficerCfo Apr 1, 2024
W-2 Managing EmployeeCfo Feb 1, 2025
The Deaconess Associations Inc Organization, Cincinnati, OH 5% Or Greater Indirect Ownership Interest Oct 1, 2018 100%
Deaconess Healthcare Holdings, Inc. Organization, Cincinnati, OH 5% Or Greater Indirect Ownership Interest Oct 1, 2018 100%
Lifespring Home Care and Hospice, LLC Organization, Norman, OK Holding company 5% Or Greater Direct Ownership Interest Oct 1, 2018 100%
Cherie Elledge Individual Corporate OfficerCeo Jan 1, 2025
W-2 Managing EmployeeCeo Jan 1, 2025

Facilities with the same owner 37

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 37

Practitioners & affiliated clinicians

Affiliated clinicians 7

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1237248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576627200000",
    "number": "1144461476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2411 SPRINGER DR",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730693955",
            "telephone_number": "405-329-4545",
            "fax_number": "405-310-3371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10207 INDIANA AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794234909",
            "telephone_number": "806-712-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORDOVA BAY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-17",
        "last_updated": "2019-12-18",
        "certification_date": "2019-12-18",
        "status": "A",
        "authorized_official_last_name": "VAHLBERG",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "405-329-4545",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TX",
            "license": "012272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204233501",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "457514",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Calvert Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.