Healthcare Provider Details

I. General information

NPI: 1912061037
Provider Name (Legal Business Name): COVENANT HOSPICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 GATEWAY DR STE C
OPELIKA AL
36801-6875
US

IV. Provider business mailing address

5041 N 12TH AVE
PENSACOLA FL
32504-8916
US

V. Phone/Fax

Practice location:
  • Phone: 334-758-1305
  • Fax: 888-837-5024
Mailing address:
  • Phone: 850-433-2155
  • Fax: 850-202-5819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberE02705
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROLAND CLENEAY
Title or Position: CFO
Credential:
Phone: 850-433-1555