1982690640 NPI number — COVENANT HOMECARE

Table of content: (NPI 1982690640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982690640 NPI number — COVENANT HOMECARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COVENANT HOMECARE
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:
1982690640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 LAKE BROOK BLVD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37909-1100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-374-0600
Provider Business Mailing Address Fax Number:
865-374-2061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 LAKE BROOK BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37909-1100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-374-0600
Provider Business Practice Location Address Fax Number:
865-374-2061
Provider Enumeration Date:
09/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HUSKEY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
865-374-0600

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  0000000133 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0152215 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 5467111 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 070036899 . This is a "EEOICPA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 100020430 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 702002087 . This is a "CARITEN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7773468 . This is a "AETNA MORRISTOWN OFFICE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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