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General NPI Number Information
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NPI Number | 1205906989
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Entity Type | Organization
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Legal Business Name | COVENANT LIVING WEST
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 07/30/2019
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Provider Practice Location Address
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Address Line | 2125 N OLIVE AVE
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City | TURLOCK
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State | CA
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Zip | 95382-1901
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Country | US
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Telephone | 209-632-9976
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Fax | 209-632-7885
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Provider Business Mailing Address
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Address Line | 2125 N OLIVE AVE
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City | TURLOCK
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State | CA
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Zip | 95382-1901
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Country | US
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Telephone | 209-632-9976
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Fax | 209-632-7885
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Authorized Official
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Title or Position | ASSOCIATE VICE PRESIDENT OF HEALTH
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Name | ELIZABETH MALZAHN
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Credential |
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Telephone | 773-878-4430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 030000694
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License Number State | CA
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