MEDICARE: COVENANT HOME HEALTHCARE, INC,

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	:	1689071649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVENANT HOME HEALTHCARE, INC,

Provider Business Mailing Address
First Line	:	29860 W 12 MILE RD APT 602
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-4040
Country	:	US
Telephone Number	:	248-778-8114
Fax Number	:	248-432-7339

Provider Business Practice Location Address
First Line	:	29860 W 12 MILE RD APT 602
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-4040
Country	:	US
Telephone Number	:	248-778-8114
Fax Number	:	248-432-7339

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MS. ANGELA L COLEMAN
Credential	:
Telephone Number	:	248-778-8114

Provider Enumeration Date	:	11/19/2014
Last Update Date	:	11/19/2014

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