Healthcare Provider Details

I. General information

NPI: 1194880690
Provider Name (Legal Business Name): COVENANT HOSPICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 10/10/2021
Certification Date: 10/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3383 S FERDON BLVD # B-5
CRESTVIEW FL
32536-8484
US

IV. Provider business mailing address

5041 N 12TH AVE
PENSACOLA FL
32504-8916
US

V. Phone/Fax

Practice location:
  • Phone: 850-682-3628
  • Fax: 850-682-8434
Mailing address:
  • Phone: 850-433-2155
  • Fax: 850-202-5819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number5025095
License Number StateFL

VIII. Authorized Official

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