Healthcare Provider Details

I. General information

NPI: 1265350250
Provider Name (Legal Business Name): COVENANT INTERNATIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9515 STONEY RIDGE RD
SPRINGDALE MD
20774-5441
US

IV. Provider business mailing address

9515 STONEY RIDGE RD
SPRINGDALE MD
20774-5441
US

V. Phone/Fax

Practice location:
  • Phone: 202-569-1100
  • Fax:
Mailing address:
  • Phone: 202-569-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. WANKA NDIFOR
Title or Position: CEO
Credential:
Phone: 240-535-3259