Healthcare Provider Details

I. General information

NPI: 1467661363
Provider Name (Legal Business Name): COVENANT HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1378 E LIVINGSTON AVE
COLUMBUS OH
43205-2922
US

IV. Provider business mailing address

880 QUITMAN DR E
GAHANNA OH
43230-2076
US

V. Phone/Fax

Practice location:
  • Phone: 614-725-4080
  • Fax: 614-725-4063
Mailing address:
  • Phone: 614-572-6792
  • Fax: 614-532-0748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: BENEDICT CHUKWUMA ODIRI
Title or Position: RN
Credential:
Phone: 614-725-4080