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General NPI Number Information
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NPI Number | 1679615611
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Entity Type | Organization
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Legal Business Name | COVENANT CARE MISSION, INC.
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 09/26/2013
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Provider Practice Location Address
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Address Line | 410 N WINCHESTER BLVD
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City | SANTA CLARA
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State | CA
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Zip | 95050-6325
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Country | US
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Telephone | 408-248-3736
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Fax | 408-247-9783
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Provider Business Mailing Address
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Address Line | 410 N WINCHESTER BLVD
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City | SANTA CLARA
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State | CA
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Zip | 95050-6325
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Country | US
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Telephone | 408-248-3736
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Fax | 408-247-9783
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Authorized Official
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Title or Position | DIRECTOR OF REIMBURSEMENT
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Name | CAROL SPARKS
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Credential |
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Telephone | 949-349-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 220000414
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License Number State | CA
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