Healthcare Provider Details

I. General information

NPI: 1245370808
Provider Name (Legal Business Name): COVENANT CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S MINE LA MOTTE ST
FREDERICKTOWN MO
63645-1229
US

IV. Provider business mailing address

120 S MINE LA MOTTE ST
FREDERICKTOWN MO
63645-1229
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 Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

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