Healthcare Provider Details

I. General information

NPI: 1437074192
Provider Name (Legal Business Name): COVENANT COMMUNITY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

5716 MICHIGAN AVE
DETROIT MI
48210-3039
US

IV. Provider business mailing address

5716 MICHIGAN AVE
DETROIT MI
48210-3039
US

V. Phone/Fax

Practice location:
  • Phone: 740-764-4670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERIC B. BLAKE
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 740-452-7685