Healthcare Provider Details

I. General information

NPI: 1649540170
Provider Name (Legal Business Name): COVENANT HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 02/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 LAKE BROOK BLVD SUITE 101
KNOXVILLE TN
37909-1100
US

IV. Provider business mailing address

3001 LAKE BROOK BLVD SUITE 101
KNOXVILLE TN
37909-1100
US

V. Phone/Fax

Practice location:
  • Phone: 865-374-0600
  • Fax: 865-374-2061
Mailing address:
  • Phone: 865-374-0600
  • Fax: 865-374-2061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number0000000364
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number0000000364
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number0000000364
License Number StateTN

VIII. Authorized Official

Name: MR. JOHN L HUSKEY
Title or Position: PRESIDENT
Credential:
Phone: 865-374-0602