1861582595 NPI number — COVENANT HOME CARE

Table of content: (NPI 1861582595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861582595 NPI number — COVENANT HOME CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COVENANT HOME CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861582595
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1223 POTTSVILLE PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHOEMAKERSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19555-1719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-726-8761
Provider Business Mailing Address Fax Number:
570-385-5287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1223 POTTSVILLE PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHOEMAKERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19555-1719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-726-8761
Provider Business Practice Location Address Fax Number:
570-385-5287
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEVENGOOD
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
800-726-8761

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  712905 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X , with the licence number: 159199 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1722 . This is a "BLUE SHIELD PROVIDER NO." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30892 . This is a "GEISINGER PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: C397129 . This is a "GATEWAY PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 397129 . This is a "BLUE CROSS PROVIDER NO." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 100773957 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 70354200 . This is a "BLACK LUNG PROVIDER NO." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007739570008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007739570007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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