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General NPI Number Information
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NPI Number | 1023173432
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Entity Type | Organization
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Legal Business Name | COVENANT HOSPICE INC
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 10/08/2021
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Provider Practice Location Address
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Address Line | 220 EGLIN PKWY NE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-2857
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Country | US
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Telephone | 850-729-1800
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Fax | 850-863-6191
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Provider Business Mailing Address
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Address Line | 5041 N 12TH AVE
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City | PENSACOLA
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State | FL
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Zip | 32504-8916
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Country | US
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Telephone | 850-433-2155
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Fax | 850-202-5819
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Authorized Official
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Title or Position | CFO
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Name | ROLAND CLENEAY
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Credential |
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Telephone | 850-433-2155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 5025095
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License Number State | FL
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