Healthcare Provider Details

I. General information

NPI: 1023173432
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: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 EGLIN PKWY NE
FORT WALTON BEACH FL
32547-2857
US

IV. Provider business mailing address

5041 N 12TH AVE
PENSACOLA FL
32504-8916
US

V. Phone/Fax

Practice location:
  • Phone: 850-729-1800
  • Fax: 850-863-6191
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: ROLAND CLENEAY
Title or Position: CFO
Credential:
Phone: 850-433-2155