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General NPI Number Information
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NPI Number | 1487749537
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Entity Type | Organization
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Legal Business Name | COVENANT CARE SERVICES, LLC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 120 S. MINE LAMOTTE
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City | FREDERICKTOWN
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State | MO
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Zip | 63645
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Country | US
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Telephone | 573-783-6256
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Fax | 573-783-8148
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Provider Business Mailing Address
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Address Line | 120 S. MINE LAMOTTE
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City | FREDERICKTOWN
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State | MO
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Zip | 63645
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Country | US
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Telephone | 573-783-6256
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Fax | 573-783-8148
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | MR. WARREN KEITH REAGAN
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Credential |
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Telephone | 573-783-6256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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