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General NPI Number Information
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NPI Number | 1558792937
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Entity Type | Organization
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Legal Business Name | COVENANT COMMUNITY CARE, INC.
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Dates
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Enumeration Date | 12/10/2013
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 17625 JOY RD
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City | DETROIT
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State | MI
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Zip | 48228-1999
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Country | US
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Telephone | 313-446-8800
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Fax | 313-446-8810
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Provider Business Mailing Address
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Address Line | 559 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48216-2200
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Country | US
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Telephone | 313-554-0485
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | ANNA GRIEBEL CHAVEZ
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Credential |
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Telephone | 313-554-0485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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