NPIMap

Organization Active NPI

Cordova Bay LLC

Doing business as Calvert Home Health

  • Home Health Agency
  • Lubbock, TX
National Provider Identifier
1760639785
Registry record updated Dec 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
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
Aug 20, 2008
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 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
204464601MedicaidTX
677078OtherTXMEDICARE 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
O20090309000156 TX Part A Provider - Home Health Agency 0648336123 Practice locations: Crosbyton, TX; Post, TX; Levelland, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760639785. Details of each certification follow.

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
LLCProprietary
Enrollment address
131 N Grain Street
Crosbyton, TX 79322-2114

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 677078 · All quality measures
Overall star rating
4 of 5
Ownership
Proprietary
Certified
Jan 9, 1987
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1093906Cordova Bay LTD131 W Grain, Crosbyton, TX 79322Certificate of waiverJan 5, 2027

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

10207 Indiana Ave
Lubbock, TX 79423
Phone (806) 712-1110

Ownership & related parties

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 OfficerCeo, 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%

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": "1219190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576627200000",
    "number": "1760639785",
    "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": "2008-08-20",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204464601",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "677078",
            "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.