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General NPI Number Information
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NPI Number | 1124683503
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Entity Type | Organization
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Legal Business Name | COVENANT HOME CARE, LLC
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Dates
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Enumeration Date | 05/01/2019
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Last Update Date | 05/01/2019
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Provider Practice Location Address
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Address Line | 3601 SHADY TIMBER DR
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City | TWINSBURG
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State | OH
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Zip | 44087-4945
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Country | US
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Telephone | 216-296-4817
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 SHADY TIMBER DR
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City | TWINSBURG
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State | OH
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Zip | 44087-4945
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Country | US
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Telephone | 216-296-4817
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Fax |
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Authorized Official
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Title or Position | OWNER, ADMINISTATOR
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Name | EBONY JAMICE JACKSON
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Credential | RN, BSN
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Telephone | 216-296-4817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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