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General NPI Number Information
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NPI Number | 1003088329
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Entity Type | Organization
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Legal Business Name | COVINGTON LEGACY INCORPORATED
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 8436 GAMBLE RD
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City | MONTICELLO
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State | FL
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Zip | 32344-7397
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Country | US
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Telephone | 850-997-8457
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Fax | 850-997-8457
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Provider Business Mailing Address
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Address Line | 8436 GAMBLE RD
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City | MONTICELLO
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State | FL
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Zip | 32344-7397
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Country | US
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Telephone | 850-997-8457
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Fax | 850-997-8457
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. EDWARD GUY COVINGTON
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Credential | LPN
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Telephone | 850-997-8457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | PN1061381
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License Number State | FL
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