Healthcare Provider Details

I. General information

NPI: 1598274664
Provider Name (Legal Business Name): COVENANT HOSPICE,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 N 9TH AVE FL 1
PENSACOLA FL
32504-8721
US

IV. Provider business mailing address

5041 N 12TH AVE
PENSACOLA FL
32504-8916
US

V. Phone/Fax

Practice location:
  • Phone: 850-262-7830
  • Fax: 850-598-2753
Mailing address:
  • Phone: 850-433-2155
  • Fax: 850-202-5803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number5025095
License Number StateFL

VIII. Authorized Official

Name: MR. ODIN G. BERG
Title or Position: CFO
Credential:
Phone: 850-433-2155