Healthcare Provider Details

I. General information

NPI: 1487749537
Provider Name (Legal Business Name): COVENANT CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S. MINE LAMOTTE
FREDERICKTOWN MO
63645
US

IV. Provider business mailing address

120 S. MINE LAMOTTE
FREDERICKTOWN MO
63645
US

V. Phone/Fax

Practice location:
  • Phone: 573-783-6256
  • Fax: 573-783-8148
Mailing address:
  • Phone: 573-783-6256
  • Fax: 573-783-8148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. WARREN KEITH REAGAN
Title or Position: MEMBER/MANAGER
Credential:
Phone: 573-783-6256