Healthcare Provider Details

I. General information

NPI: 1508713553
Provider Name (Legal Business Name): MARY'S COVENANT CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 LINDELL BLVD STE 200&300
SAINT LOUIS MO
63108-3725
US

IV. Provider business mailing address

4625 LINDELL BLVD STE 200&300
SAINT LOUIS MO
63108-3725
US

V. Phone/Fax

Practice location:
  • Phone: 636-634-0733
  • Fax:
Mailing address:
  • Phone: 636-634-0733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EBONY WASHINGTON
Title or Position: OWNER/ADMINISTRATOR
Credential: MBA
Phone: 636-634-0733