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General NPI Number Information
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NPI Number | 1649392127
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Entity Type | Organization
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Legal Business Name | COVENANT COVE FAMILY CARE HOME, INC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1189 GAINEY RD
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City | RAEFORD
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State | NC
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Zip | 28376-6857
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Country | US
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Telephone | 910-848-1224
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Fax | 910-848-0129
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Provider Business Mailing Address
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Address Line | 1189 GAINEY RD
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City | RAEFORD
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State | NC
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Zip | 28376-6857
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Country | US
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Telephone | 910-848-1224
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Fax | 910-848-0129
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. ROBERT EDWARD ALFORD
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Credential |
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Telephone | 910-848-1224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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