Healthcare Provider Details

I. General information

NPI: 1205906989
Provider Name (Legal Business Name): COVENANT LIVING WEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 N OLIVE AVE
TURLOCK CA
95382-1901
US

IV. Provider business mailing address

2125 N OLIVE AVE
TURLOCK CA
95382-1901
US

V. Phone/Fax

Practice location:
  • Phone: 209-632-9976
  • Fax: 209-632-7885
Mailing address:
  • Phone: 209-632-9976
  • Fax: 209-632-7885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030000694
License Number StateCA

VIII. Authorized Official

Name: ELIZABETH MALZAHN
Title or Position: ASSOCIATE VICE PRESIDENT OF HEALTH
Credential:
Phone: 773-878-4430