MEDICARE: COVENANT HOME HEALTH AGENCY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	1529356	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184657520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVENANT HOME HEALTH AGENCY LLC

Provider Business Mailing Address
First Line	:	2105 S HAMILTON RD
Second Line	:	SUITE 219
City	:	COLUMBUS
State	:	OH
Zip	:	43232
Country	:	US
Telephone Number	:	614-522-0521
Fax Number	:	614-522-0525

Provider Business Practice Location Address
First Line	:	2105 S HAMILTON RD
Second Line	:	SUITE 219
City	:	COLUMBUS
State	:	OH
Zip	:	43232
Country	:	US
Telephone Number	:	614-522-0521
Fax Number	:	614-522-0525

Authorized Official
Title or Position	:	OWNER ADMINISTRATOR
Name	:	MS. TONYA LOUISE FIELDS
Credential	:
Telephone Number	:	614-522-0521

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	08/22/2020

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