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General NPI Number Information
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NPI Number | 1467764100
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Entity Type | Organization
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Legal Business Name | COVENANT CARE, LLC
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Dates
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Enumeration Date | 07/10/2010
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Last Update Date | 08/05/2010
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Provider Practice Location Address
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Address Line | 6 W COUNTY ST STE. 108
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City | HAMPTON
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State | VA
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Zip | 23663-2336
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Country | US
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Telephone | 757-224-9944
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Fax | 757-224-2659
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Provider Business Mailing Address
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Address Line | 6 WEST COUNTY ST. STE. 108
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City | HAMPTON
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State | VA
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Zip | 23663-2366
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Country | US
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Telephone | 757-224-9944
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Fax | 757-224-2659
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. KARON J SHIELDS
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Credential |
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Telephone | 757-224-9944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HCO-10669
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License Number State | VA
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