Healthcare Provider Details

I. General information

NPI: 1912824236
Provider Name (Legal Business Name): COVENANT HOUSE MRDD SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 SEYMOUR AVE
COLUMBUS OH
43205-2566
US

IV. Provider business mailing address

479 SEYMOUR AVE
COLUMBUS OH
43205-2566
US

V. Phone/Fax

Practice location:
  • Phone: 614-309-0395
  • Fax: 614-252-6787
Mailing address:
  • Phone: 614-309-0395
  • Fax: 614-252-6787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: MR. BOB HENRY DUCKENS SR.
Title or Position: C.E.O
Credential:
Phone: 614-561-0390