Healthcare Provider Details

I. General information

NPI: 1174885289
Provider Name (Legal Business Name): COVENANT HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 02/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W TENNESSEE AVE SUITE A
OAK RIDGE TN
37830-6501
US

IV. Provider business mailing address

150 W TENNESSEE AVE SUITE A
OAK RIDGE TN
37830-6501
US

V. Phone/Fax

Practice location:
  • Phone: 865-374-0600
  • Fax: 865-374-2059
Mailing address:
  • Phone: 865-374-0600
  • Fax: 865-374-2059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

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