Healthcare Provider Details

I. General information

NPI: 1619208550
Provider Name (Legal Business Name): THE COVENTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6898 S 2300 E
SLC UT
84121-3195
US

IV. Provider business mailing address

6898 S 2300 E
SLC UT
84121-3195
US

V. Phone/Fax

Practice location:
  • Phone: 801-943-5858
  • Fax: 801-943-8009
Mailing address:
  • Phone: 801-943-5858
  • Fax: 801-943-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DEVIN S ALLRED
Title or Position: EXECUITVE DIRECTOR
Credential: HFA, CMCA, CAM
Phone: 801-943-5858