Healthcare Provider Details

I. General information

NPI: 1407295280
Provider Name (Legal Business Name): COVENANT FAMILY SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 1ST AVE NE STE 300
CEDAR RAPIDS IA
52402-4832
US

IV. Provider business mailing address

2720 1ST AVE NE STE 300
CEDAR RAPIDS IA
52402-4832
US

V. Phone/Fax

Practice location:
  • Phone: 888-336-9661
  • Fax: 319-200-2516
Mailing address:
  • Phone: 888-336-9661
  • Fax: 319-200-2516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier600879703
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: JACOB DUSTIN CHRISTENSON
Title or Position: CEO
Credential: PHD
Phone: 319-261-2292