MEDICARE: COVENANT CARE HOMECARE 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

General Provider Information

NPI Number	:	1548101009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVENANT CARE HOMECARE LLC

Provider Business Mailing Address
First Line	:	72 SPRINGSIDE RD
Second Line	:
City	:	RED SPRINGS
State	:	NC
Zip	:	28377-9749
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	72 SPRINGSIDE RD
Second Line	:
City	:	RED SPRINGS
State	:	NC
Zip	:	28377-9749
Country	:	US
Telephone Number	:	910-384-2670
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DEREK ELLIS
Credential	:
Telephone Number	:	910-384-2670

Provider Enumeration Date	:	04/01/2026
Last Update Date	:	04/01/2026

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