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General NPI Number Information
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NPI Number | 1205197456
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Entity Type | Organization
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Legal Business Name | COVENANT CARE IN-HOME AGENCY LLC.
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Dates
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Enumeration Date | 06/05/2012
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Last Update Date | 06/05/2012
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Provider Practice Location Address
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Address Line | 6000 WEST FLORISSANT
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City | ST. LOUIS
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State | MO
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Zip | 63136
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Country | US
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Telephone | 314-381-0928
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Fax | 314-383-2873
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Provider Business Mailing Address
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Address Line | 5979 N. POINTE BLVD.
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City | ST. LOUIS
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State | MO
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Zip | 63147
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Country | US
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Telephone | 314-381-0928
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Fax | 314-383-2873
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. GELIS DEON HARRIS
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Credential |
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Telephone | 314-898-6916
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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 | MO
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