Healthcare Provider Details

I. General information

NPI: 1942335062
Provider Name (Legal Business Name): COVENANT CARE ORANGE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13007 SOUTH PARAMOUNT BLVD
DOWNEY CA
90242-4329
US

IV. Provider business mailing address

13007 SOUTH PARAMOUNT BLVD
DOWNEY CA
90242-4329
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-9301
  • Fax: 562-923-3503
Mailing address:
  • Phone: 562-923-9301
  • Fax: 562-923-3503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number940000176
License Number StateCA

VIII. Authorized Official

Name: CAROL SPARKS
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 949-349-1200