# CALVERT CITY CONVALESCENT CENTER, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588650618
- **Authorized official:** MRS. LAURIE M TRAVIS (ASST BUSINESS ADMN)
- **Authorized official phone:** (270) 395-4124

## Contact information

- **Practice address:** 1201 5TH AVE, CALVERT CITY, KY 42029-8233
- **Practice address phone:** (270) 395-4124
- **Practice address fax:** (270) 395-4962
- **Mailing address:** 1201 5TH AVE, PO BOX 7, CALVERT CITY, KY 42029-8233
- **Mailing address phone:** (270) 395-4124
- **Mailing address fax:** (270) 395-4962

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 09/23/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 12500443 | — | KY |