Healthcare Provider Details

I. General information

NPI: 1023562865
Provider Name (Legal Business Name): COVENANT HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 10/10/2021
Certification Date: 10/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 AIRPORT BLVD. MAIN TOWER, 11TH FLOOR NORTH
MOBILE AL
36608
US

IV. Provider business mailing address

5041 N. 12TH AVE.
PENSACOLA FL
32504
US

V. Phone/Fax

Practice location:
  • Phone: 850-433-2155
  • Fax:
Mailing address:
  • Phone: 850-433-2155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number5025095
License Number StateFL

VIII. Authorized Official

Name: ROLAND CLENEAY
Title or Position: CFO
Credential:
Phone: 850-433-2155