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Cordova Bay LLC

Organization Active NPI Home Health Agency · Lubbock, TX

NPI 1760639785 · NPPES record last updated Dec 18, 2019

Key facts

NPI
1760639785
Entity type
Organization (NPI type 2)
Primary specialty
Home Health Agency 251E00000X
Legal business name
CORDOVA BAY LLC
Practice address
10207 Indiana Ave
Lubbock, TX 79423-4909
Phone
(806) 712-1110
NPI assigned
Aug 20, 2008
Organization subpart
No

Authorized official

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

Other NPIs with the same Medicare PAC ID 1

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

Corporate family (same tax ID) 1

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

Facilities with the same owner 37

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

View all 37

Affiliated clinicians 7

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

Medicare Care Compare: Home health agency

Listed as
Calvert Home Health Care LTD CCN 677078
Overall star rating
★★★★☆ 4 of 5
Ownership
Proprietary
Certified
Jan 9, 1987
Medicare certification status
Active (Provider of Services file)
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Source: Medicare Care Compare.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1093906Cordova Bay LTD
131 W Grain, Crosbyton, TX 79322		Certificate of waiverJan 5, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in TX

Home health agency certification: CCN 677078

Legal name
CORDOVA BAY LLC
Doing business as
CALVERT HOME HEALTH CARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jan 9, 1987
Last certification
May 12, 2021
Ownership / control type
Proprietary
Organization structure
LLC · Proprietary
Enrollment address
131 N Grain Street
Crosbyton, TX 79322-2114

All disclosed owners & managing parties 4

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

NameRoleSinceShare
The Deaconess Associations Inc
Organization · Cincinnati, OH
Corporation, Non-profit 		5% Or Greater Indirect Ownership Interest Oct 1, 2018 100%
Karen E Vahlberg
Individual 		Corporate Officer
Ceo, Manager		 Oct 8, 2018 25%
W-2 Managing Employee Oct 8, 2018
Deaconess Healthcare Holdings, Inc.
Organization · Cincinnati, OH
Corporation 		5% Or Greater Indirect Ownership Interest Oct 1, 2018 100%
Lifespring Home Care and Hospice, LLC
Organization · Norman, OK
LLC, Holding company 		5% Or Greater Direct Ownership Interest Oct 1, 2018 100%

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20090309000156 TX Part a Provider - Home Health Agency 0648336123 Practice locations: Crosbyton, TX; Post, TX; Levelland, TX

National Provider Directory

Tax ID family
Calvert Home Health (2 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Yes

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

IdentifierTypeStateIssuer
677078OtherTXMEDICARE PROVIDER NUMBER
204464601MedicaidTX

Other names

  • Calvert Home Health Doing business as

Other providers in Lubbock, TX

All providers in Lubbock, TX · Home Health Agency in Texas

Sources for this page

Verify at the official NPI Registry.