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General NPI Number Information
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NPI Number | 1205076445
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Entity Type | Organization
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Legal Business Name | COVENANT IN HOME SERVICES LLC
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Dates
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Enumeration Date | 02/28/2009
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Last Update Date | 02/28/2009
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Provider Practice Location Address
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Address Line | 224 ABINGTON DR
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City | SAINT PETERS
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State | MO
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Zip | 63376-8180
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Country | US
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Telephone | 636-978-0933
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Fax |
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Provider Business Mailing Address
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Address Line | 8227 PAGE AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63130-1116
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Country | US
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Telephone | 314-890-0025
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Fax | 314-890-0194
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Authorized Official
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Title or Position | DESIGNATED MANAGER/DIRECTOR
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Name | MS. TERRELL LYNN SIMMS
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Credential |
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Telephone | 314-361-1935
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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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