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General NPI Number Information
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NPI Number | 1629249933
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Entity Type | Organization
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Legal Business Name | COVENANT HEALTH CARE SERVICES,LLC
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 10115 BARTLEY WAY
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City | LANHAM
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State | MD
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Zip | 20706-2385
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Country | US
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Telephone | 301-731-1366
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Fax | 301-731-1944
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Provider Business Mailing Address
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Address Line | 10115 BARTLEY WAY
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City | LANHAM
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State | MD
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Zip | 20706-2385
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Country | US
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Telephone | 301-731-1366
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Fax | 301-731-1944
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Authorized Official
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Title or Position | DEPUTY ADMINISTRATOR
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Name | MR. DWIGHT LORENZO BYNUM
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Credential |
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Telephone | 301-437-2844
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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 | R2460
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License Number State | MD
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