Healthcare Provider Details

I. General information

NPI: 1487641361
Provider Name (Legal Business Name): COVENANT CARE CALIFORNIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620B DALE RD
MODESTO CA
95356-0500
US

IV. Provider business mailing address

3620B DALE RD
MODESTO CA
95356-0500
US

V. Phone/Fax

Practice location:
  • Phone: 209-521-2094
  • Fax: 209-521-6180
Mailing address:
  • Phone: 209-521-2094
  • Fax: 209-521-6180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUSAN P MORGAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 209-521-2094