Healthcare Provider Details

I. General information

NPI: 1962400077
Provider Name (Legal Business Name): COVENANT HOME HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11375 ROBINSON DR NW SUITE 104
COON RAPIDS MN
55433-2590
US

IV. Provider business mailing address

11375 ROBINSON DR NW SUITE 104
COON RAPIDS MN
55433-2590
US

V. Phone/Fax

Practice location:
  • Phone: 763-755-9009
  • Fax: 763-862-8030
Mailing address:
  • Phone: 763-755-9009
  • Fax: 763-862-8030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number328094
License Number StateMN

VIII. Authorized Official

Name: MRS. GLORIA JEAN KLINEFELTER
Title or Position: PRESIDENT/ADMINISTRATOR
Credential:
Phone: 763-755-9009