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General NPI Number Information
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NPI Number | 1114066735
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Entity Type | Organization
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Legal Business Name | COVENANT HOMES LLC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8214 FREDONIA RD
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City | RICHMOND
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State | VA
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Zip | 23227-1532
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Country | US
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Telephone | 804-553-0129
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Fax | 804-553-0130
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Provider Business Mailing Address
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Address Line | 8214 FREDONIA RD
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City | RICHMOND
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State | VA
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Zip | 23227-1532
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Country | US
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Telephone | 804-553-0129
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Fax | 804-553-0130
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. INGER D WYATT
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Credential |
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Telephone | 804-553-0129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 735-01-001
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License Number State | VA
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