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General NPI Number Information
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NPI Number | 1669424826
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Entity Type | Organization
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Legal Business Name | COVENANT HOME HEALTH CARE OF STOW-GLEN INC
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 4285 KENT RD
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City | STOW
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State | OH
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Zip | 44224-4355
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Country | US
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Telephone | 330-686-7159
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Fax | 330-686-7294
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Provider Business Mailing Address
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Address Line | 4285 KENT RD
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City | STOW
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State | OH
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Zip | 44224-4355
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Country | US
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Telephone | 330-686-7159
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Fax | 330-686-7294
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. TAMMY LYNN DENTON
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Credential | LNHA
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Telephone | 330-686-7170
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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 | 36-8069
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License Number State | OH
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