=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184657520
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COVENANT HOME HEALTH AGENCY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2105 S HAMILTON RD SUITE 219
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-522-0521
-----------------------------------------------------
Fax | 614-522-0525
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2105 S HAMILTON RD SUITE 219
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-522-0521
-----------------------------------------------------
Fax | 614-522-0525
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER ADMINISTRATOR
-----------------------------------------------------
Name | MS. TONYA LOUISE FIELDS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-522-0521
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1529356
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------