Healthcare Provider Details

I. General information

NPI: 1770852634
Provider Name (Legal Business Name): COVENANT COMMUNITY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5716 MICHIGAN AVE
DETROIT MI
48210-3039
US

IV. Provider business mailing address

559 W GRAND BLVD
DETROIT MI
48216-2200
US

V. Phone/Fax

Practice location:
  • Phone: 313-554-3880
  • Fax: 313-899-3550
Mailing address:
  • Phone: 313-554-0485
  • Fax: 132-280-2833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ANNA GRIEBEL CHAVEZ
Title or Position: CFO
Credential:
Phone: 313-554-0485