Healthcare Provider Details

I. General information

NPI: 1083321863
Provider Name (Legal Business Name): COVENANT BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 DIXIE HWY
CHICAGO HEIGHTS IL
60411-2622
US

IV. Provider business mailing address

1045 DIXIE HWY
CHICAGO HEIGHTS IL
60411-2622
US

V. Phone/Fax

Practice location:
  • Phone: 708-964-7983
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ADENIKE AKOREDE
Title or Position: PRESIDENT
Credential:
Phone: 708-964-7983