Healthcare Provider Details

I. General information

NPI: 1023933512
Provider Name (Legal Business Name): COVENANT HEALTH TRANSPORTATION SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 S 5TH AVENUE
MAYWOOD IL
60153
US

IV. Provider business mailing address

1311 S 5TH AVENUE
MAYWOOD IL
60153
US

V. Phone/Fax

Practice location:
  • Phone: 708-731-3104
  • Fax: 708-731-3175
Mailing address:
  • Phone: 708-731-3104
  • Fax: 708-731-3175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: GORDON EGBUNA
Title or Position: PRESIDENT
Credential:
Phone: 708-731-3104