MEDICARE: COVENANT HEALTH SERVICES 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	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1467661363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVENANT HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	880 QUITMAN DR E
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-2076
Country	:	US
Telephone Number	:	614-572-6792
Fax Number	:	614-532-0748

Provider Business Practice Location Address
First Line	:	1378 E LIVINGSTON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-2922
Country	:	US
Telephone Number	:	614-725-4080
Fax Number	:	614-725-4063

Authorized Official
Title or Position	:	RN
Name	:	BENEDICT CHUKWUMA ODIRI
Credential	:
Telephone Number	:	614-725-4080

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/17/2012

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