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General NPI Number Information
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NPI Number | 1467705707
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Entity Type | Organization
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Legal Business Name | COVENANT LIFE CHRISTIAN CENTER INC
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Dates
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Enumeration Date | 10/24/2012
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Last Update Date | 10/24/2012
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Provider Practice Location Address
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Address Line | 507 N HIGHWAY 77 STE 410-412
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City | WAXAHACHIE
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State | TX
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Zip | 75165-1885
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Country | US
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Telephone | 972-937-5129
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Fax | 972-937-9219
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Provider Business Mailing Address
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Address Line | PO BOX 2509
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City | WAXAHACHIE
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State | TX
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Zip | 75168-8509
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Country | US
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Telephone | 972-937-5129
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Fax | 972-937-9219
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Authorized Official
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Title or Position | PRESIDENT
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Name | GERALD RAY PARSONS
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Credential |
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Telephone | 972-921-1152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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