1740626829 NPI number — COVENANT HOME SERVICES

Table of content: (NPI 1740626829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740626829 NPI number — COVENANT HOME SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COVENANT HOME SERVICES
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:
COVENANTCARE HOSPICE
Provider Other Organization Name Type Code:
3
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:
1740626829
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5700 OLD ORCHARD ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SKOKIE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-878-2295
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 N BROADWAY STE 1B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TURLOCK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95380-4811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-664-2550
Provider Business Practice Location Address Fax Number:
209-664-2557
Provider Enumeration Date:
05/16/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MALZAHN
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT OF HEALTH SERVICES
Authorized Official Telephone Number:
773-878-4430

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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