Healthcare Provider Details

I. General information

NPI: 1790372837
Provider Name (Legal Business Name): COVENANT HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MEMORIAL DR
AVON MA
02322-1918
US

IV. Provider business mailing address

11 MEMORIAL DR
AVON MA
02322-1918
US

V. Phone/Fax

Practice location:
  • Phone: 617-980-3975
  • Fax:
Mailing address:
  • Phone: 617-980-3975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MRS. FREDA AGBOGA
Title or Position: SECRETARY
Credential:
Phone: 617-980-3975